[27] Safety of pre-intended en bloc renal pedicle control for laparoscopic nephrectomy

Objective: To evaluate preoperatively intended en bloc renal pedicle control for laparoscopic nephrectomy in our hospital, as the safety and efficacy of en bloc renal pedicle control has been approved for laparoscopic nephrectomy but some authors do not advocate the generalised use of it. Methods: We reviewed all laparoscopic nephrectomies that were carried out by two laparoscopic surgeons (from January 2015 until April 2017) who had a preoperative intention of en bloc renal pedicle control. By creating a window at the lower pole and another window at upper pole then using the Covidien Endo-GIA™ (45,60 mm vascular reload) to control the pedicle. We analysed patients’ demographic data, nephrectomy indication, intraoperative findings, and intra- and postoperative complications. Patients were followed-up with blood pressure measurements and for the presence or absence of any signs of hyperdynamic circulation. The analysis of data was done using SPSS® version 20 (SPSS Inc., IBM Corp., Armonk, NY, USA). Results: We found 38 laparoscopic nephrectomies done for patients with mean (range) age 55.7 (18–94) years and mean (range) body mass index of 29.2 (17–41) kg/m2. The indications for nephrectomy were variable: 22 patients (57.9%) for non-functioning kidney, 14 (36.8%) for renal tumours and two (5.2%) for ureteric tumours. There were 23 left nephrectomies and 15 right nephrectomies performed laparoscopically. There were no conversions to open technique and no intraoperative complications. There was an average blood loss of 75 mL and the mean (range) total laparoscopic time was 85 (45–125) min. All cases had no significant postoperative complications, apart from one who developed a postoperative collection and pleural effusion that required a chest tube and drainage. During the follow-up, none of the patients developed signs of an arteriovenous fistula. Conclusion: Pre-intended en bloc renal pedicle control during laparoscopic nephrectomies is safe using the Endo-GIA vascular stapler without significant complications