En Bloc Stapling of Renal Hilum During Hand-Assisted Retroperitoneoscopic Nephroureterectomy in Dialysis Patients

Abstract

To report our experience in routine en bloc stapling of the renal hilum during hand-assisted retroperitoneoscopic nephroureterectomy in dialysis patients. From October 2003 to June 2006, hand-assisted retroperitoneoscopic nephroureterectomy with open bladder cuff excision for upper tract transitional cell carcinoma was performed in 23 dialysis patients. En bloc mass stapling of the renal pedicle with an endovascular gastrointestinal anastomosis (Endo-GIA) stapler without individual dissection of the renal artery and vein was done. All procedures were successful. No hilar bleeding was encountered during the process of hilar division. The overall success rate of en bloc stapling to control the renal hilum in the 23 patients was 100%. The average patient age was 59.0 years (range 32-78), the operative time was 177.3 minutes (range 135-343), and the estimated blood loss was 117 mL (range 50-500). The time to oral intake and ambulation was 2.0 and 3.1 days, respectively. Two patients had postoperative complications, one pneumonia and the other wound hematoma. No immediate or short-term complications were related to this method of en bloc hilar division. No case of symptoms or imaging findings of arteriovenous fistula had developed at a mean follow-up of 24.5 months. No statistically significant difference was found in preoperative and postoperative systolic and diastolic blood pressure. Routine use of en bloc stapling and division of the renal pedicle in dialysis patients with upper urinary tract transitional cell carcinoma is safe. Without separating the renal artery from the vein with the laparoscopic instrument, the risk of hilar bleeding can be avoided.