Ligation of the Renal Vein During Laparoscopic Nephrectomy: An Effective And Reliable Method to Replace Vascular Staplers
Abstract
Purpose:
Application of the endovascular gastrointestinal anastomosis stapler has become a standard procedure to control renal vein during laparoscopic nephrectomy. However, device malfunction resulting in significant complications has been reported. We present a safe and cost-effective technique for renal vein ligation during laparoscopic nephrectomy.
Materials and Methods:
From October 2002 to April 2003 we applied our new technique of renal vein ligation in 20 cases. After renal pedicle dissection the renal artery was secured with Hem-o-lok (Weck Closure Systems, Research Triangle Park, North Carolina) clips. The renal vein was encircled with a suture, which was knotted extracorporeally and pushed down by a knot pusher to shrivel a vein of any size. Subsequently 10 mm Hem-o-lok clips were applied to the vein to occlude it completely.
Results:
All procedures were successfully completed. The operative costs of vein ligation were decreased. There was no significant increase in mean operative time.
Conclusions:
Our approach is a safe, reliable, rapid and inexpensive method to ligate the renal vein during laparoscopic nephrectomy. Therefore, this technique has replaced endovascular gastrointestinal anastomosis stapler use at our center.
References
- 1 : Laparoscopic nephrectomy: initial case report. J Urol1991; 146: 278. Link, Google Scholar
- 2 : Laparoscopic nephrectomy: the experience of the laparoscopy working group of the German Urologic Association. J Urol1998; 160: 18. Link, Google Scholar
- 3 : Multi-institutional study of complications in 1085 laparoscopic urologic procedures. Urology2001; 58: 899. Google Scholar
- 4 : Rapid ligation of renal hilum during transperitoneal laparoscopic nephrectomy. Urology2001; 57: 360. Google Scholar
- 5 : Endovascular gastrointestinal stapler device malfunction during laparoscopic nephrectomy: early recognition and management. J Urol2000; 164: 319. Link, Google Scholar
- 6 : Laparoscopic linear cutting stapler failure. Urology2002; 60: 415. Google Scholar
- 7 United States Federal Drug Administration Manufacturer and User Facility Device Experience Database (MAUDE). Available at. http://www.fda.gov/cdrh/maude.html. Accessed February 18, 2003. Google Scholar
- 8 : Laparoscopic surgery for stage T1 renal cell carcinoma: radical nephrectomy and wedge resection. Eur Urol2000; 38: 131. Google Scholar
- 9 : A comparison of the strength of knots tied by hand and at laparoscopy. J Am Coll Surg1996; 182: 46. Google Scholar
- 10 : Ligation of the renal pedicle during laparoscopic nephrectomy: a comparison of staples, clips and sutures. J Laparoendosc Surg1993; 3: 9. Google Scholar
From the Department of Urology, Elisabethinen Hospital, Linz, Austria
