Evaluation of surgical staples for ligation of the renal pedicle during nephrectomy

Abstract

A mechanical stapling instrument was evaluated for ligation of the renal pedicle during nephrectomy in nine healthy sheep. Two forms of disposable loading unit, from which stainless steel surgical staples could be dispensed in double or triple staggered row configuration, were assessed for their proper function when applied across the renal pedicle singularly or in series. The response of the sheep to surgery was assessed by physical, hematological, and serum chemistry evaluations. Tissue healing was determined by gross and histopathological examinations. Ligation and transection of the pedicle took 2 to 4 minutes. The vessels of the pedicle ranged in diameter from 3 to 12 mm. In two sheep, overzealous stripping of perivascular tissue from the renal pedicle prior to placement of a triple staggered row of staples resulted in mild hemorrhage from the renal stump. This was controlled by placing a second triple staggered row of staples proximal to the first. It was concluded that ligation of the renal pedicle could be performed rapidly, effectively, and safely in healthy sheep using the correctly applied mechanical stapler. It is inferred that a similar technique would be applicable to other species including man.