Safety of En Bloc Ligation of the Renal Hilum During Laparoscopic Radical Nephrectomy for Renal Cell Carcinoma: A Randomized Controlled Trial

Abstract

Aim: To evaluate the safety of en bloc stapler ligation of the renal vascular pedicle during laparoscopic radical nephrectomy for renal cell carcinoma. Subjects and Methods: Clinical data were collected prospectively from 70 patients who underwent either en bloc stapling of the renal hilum (n = 35) (Group A) or the separate ligation method (n = 35) (Group B) to treat renal cell carcinoma. To evaluate the incidence of arteriovenous fistula (AVF), blood pressure and heart rate were measured, and abdominal auscultation was performed at 1 month, 3 months, 6 months, and 12 months post-surgery. Abdominal computed tomography was also performed at 6 and 12 months post-surgery. In addition, preoperative characteristics and postoperative outcomes (such as operation time and estimated blood loss [EBL]) were examined. Results: Both operation time and EBL were lower for Group A: operative time, Group A versus Group B, 60.26 +/- 10.94 minutes versus 67.51 +/- 10.49 minutes (P = .007); EBL, Group A versus Group B, 33.53 +/- 13.46 mL versus 49.14 +/- 32.21 mL (P = .011). No statistically significant differences were noted in either of the postoperative variables (blood pressure and heart rate), and there was no clinical evidence of bruit or AVF at 12 months post-surgery. Conclusions: No AVF was observed after en bloc ligation upon clinical follow-up or on radiological evaluation.