Complications Related to the Renal Hilar Dissection

Renal hilar complications can occur from bleeding, CO2 gas embolus, or misidentification of the vascular structures Meraney et al. in 2002 (8). Reported an incidence of vascular complications of 1.7%.

Bleeding from the renal hilum is avoided by meticulous dissection with circumferential control and isolation of the vessels prior to applying clips or the vascular Endo-GIA e stapler.

The use of metal surgical clips to correct surgical bleeding should be done judiciously so that clip placement does not interfere with later division of the renal vein with the Endo GIA vascular stapler. Clips caught in the jaws of the stapler will prevent firing of the stapler.

If a hole is made in the renal vein and the insufflation pressure within the retroperi-toneum exceeds the venous pressure, CO2 embolization through the hole is possible. Prompt recognition of the injury is necessary so that the problem can be safely corrected. The vein should be compressed with an atraumatic forceps or alternatively compressed with a forceps padded with absorbable Surgicele after which the vein is sealed and divided with an endo-GIA vascular stapler.

Vascular structures that may be confused for renal vessels include the inferior vena cava on the right side, which can, on occasion, have the appearance of the right renal vein, and the superior mesenteric artery, which potentially could be confused on the left side with the renal artery. Complications to these vessels are avoided by correctly identifying these vessels as nonrenal vessels by observing the vessels not entering the renal hilum.

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