Feasibility and safety of renal artery closure with advanced bipolar energy device during nephrectomy

Abstract

Introduction: Many devices are available to control the renal pedicle during nephrectomy but the gold standard is still a matter of debate. Nanotechnology has evolved to include vessel-sealing systems; companies guarantee an efficacy for vessels until 7 mm. The aim of our study is to evaluate feasibility and safety of closure of the renal artery with radiofrequency energy during nephrectomy. Methods: We retrospectively evaluated consecutive patients undergoing nephrectomy between November 2016 and July 2020. Inclusion criteria were: renal artery diameter <7 mm and no significant arterial wall calcification. The EnSeal device was used in all cases for dissection, hemostasis and to secure the renal artery when feasible. Results: Overall 101 patients underwent nephrectomy, in 68 cases the radiofrequency alone was used to close the renal artery; in 45 patients during a laparoscopic procedure and in 23 during an open surgery. Conversion to open surgery was never necessary. No patients had major hemorrhagic complications. Mean operative time was 75 min, mean intraoperative blood loss was 85 ml. Overall 11 patients had postoperative complications, according to Clavien-Dindo: five grade I, three grade II, three grade III. Discussion: In our experience the closure of the renal artery with a radiofrequency energy device is a feasible and safe procedure. It allows a safe manipulation of the renal hilum, free from clips, which could limit surgeons’ maneuvers and be dislocated. We believe that a deep knowledge of the available technologies is fundamental for the surgeon and guarantees the best achievable results.