En-Bloc Stapler versus Clips for Hilar Vascular Control in Laparoscopic Nephrectomy
Journal of the Society of Laparoscopic and Robotic Surgeons, cilt.30, sa.1, 2026 (SCI-Expanded, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 30 Sayı: 1
- Basım Tarihi: 2026
- Doi Numarası: 10.4293/jsls.2025.00126
- Dergi Adı: Journal of the Society of Laparoscopic and Robotic Surgeons
- Derginin Tarandığı İndeksler: Science Citation Index Expanded (SCI-EXPANDED), Scopus, MEDLINE, Biomedical Reference Collection: Corporate Edition (EBSCO)
- Anahtar Kelimeler: Laparoscopy, Nephrectomy, Renal artery, Renal veins
- Sağlık Bilimleri Üniversitesi Adresli: Evet
Özet
Background: Laparoscopic nephrectomy is widely preferred for its advantages over open surgery, and secure hilar control is a critical procedural step. Although both clips and staplers are commonly used, studies comparing these techniques outside the setting of donor nephrec-tomy remain limited. This study evaluates the safety and effectiveness of en-bloc stapler ligation versus separate arterial and venous clipping. Materials and Methods: This retrospective study included patients aged 18–80 who underwent laparoscopic nephrec-tomy between 2020 and 2025. Demographic, perioperative, and postoperative data were collected, and complications were classified using the Clavien–Dindo system. Hilar control was performed either by en-bloc stapling or separate clipping. Statistical analyses included comparative tests and logistic regression, with significance set at P < .05. Results: A total of 171 patients were analyzed (80 EndoGIA, 91 clip). Baseline characteristics were compa-rable. Operative time (122 vs 135 minutes; P = .004) and blood loss (175 vs 198 mL; P = .025) were lower in the EndoGIA group. Overall complication rates were similar (30% vs 28.5%; P 5 .500), with mostly grade I–II. Major complications were rare in both groups. No arteriove-nous fistulas were detected after en-bloc stapling. Multivariate analysis identified prolonged operative time and chronic obstructive pulmonary disease (COPD) as in-dependent predictors of postoperative complications. Conclusion: Both en-bloc stapler ligation and separate clipping are safe methods for hilar control in laparoscopic nephrectomy. En-bloc stapling may reduce operative time and associated complications, offering particular advantages in complex dissections or when minimizing surgery duration is critical, thereby supporting its broader adoption in clinical practice.