Simplified hemostatic technique during laparoscopic partial nephrectomy
INTRODUCTION: Laparoscopic partial nephrectomy (LPN) has gained popularity in recent years, although it remains a challenging procedure. Herein we describe our technique of renal defect closure using sutures as the sole means of hemostasis during LPN. SURGICAL TECHNIQUE: The kidney is approached transperitoneally in a standard fashion. After the renal artery is clamped and the tumor has been excised, the defect is closed in two separate knot-free suture layers. The deep layer suture is continuous and involves deep parenchyma including the collecting system, if opened. The superficial layer suture approximates the margins of the defect using absorbable clips on one parenchymal edge only. No bolsters, glues or other additional hemostatic agents are used. RESULTS: At present this technique was applied in 34 patients. Tumor size ranged from 17-85 mm. Median warm ischemia time was 23 min (range 12-45) and estimated blood loss 55 mL (30-1000). There were no intraoperative complications or conversions to open surgery. No urine leaks or postoperative bleedings were observed. CONCLUSIONS: This simplified technique appears reliable and quick, and therefore may be attractive for many urologic surgeons. Furthermore, the avoidance of routine use of additional hemostatic maneuvers may provide an economical advantage to this approach with no compromise of the surgical outcome.
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Sociedade Brasileira de Urologia
2012
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oai:scielo:S1677-553820120001000122012-03-28Simplified hemostatic technique during laparoscopic partial nephrectomyTsivian,AlexanderTsivian,MatveyBenjamin,ShalvaSidi,Ami A. laparoscopy kidney nephrectomy surgery hemostatic techniques INTRODUCTION: Laparoscopic partial nephrectomy (LPN) has gained popularity in recent years, although it remains a challenging procedure. Herein we describe our technique of renal defect closure using sutures as the sole means of hemostasis during LPN. SURGICAL TECHNIQUE: The kidney is approached transperitoneally in a standard fashion. After the renal artery is clamped and the tumor has been excised, the defect is closed in two separate knot-free suture layers. The deep layer suture is continuous and involves deep parenchyma including the collecting system, if opened. The superficial layer suture approximates the margins of the defect using absorbable clips on one parenchymal edge only. No bolsters, glues or other additional hemostatic agents are used. RESULTS: At present this technique was applied in 34 patients. Tumor size ranged from 17-85 mm. Median warm ischemia time was 23 min (range 12-45) and estimated blood loss 55 mL (30-1000). There were no intraoperative complications or conversions to open surgery. No urine leaks or postoperative bleedings were observed. CONCLUSIONS: This simplified technique appears reliable and quick, and therefore may be attractive for many urologic surgeons. Furthermore, the avoidance of routine use of additional hemostatic maneuvers may provide an economical advantage to this approach with no compromise of the surgical outcome.info:eu-repo/semantics/openAccessSociedade Brasileira de UrologiaInternational braz j urol v.38 n.1 20122012-02-01info:eu-repo/semantics/articletext/htmlhttp://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382012000100012en10.1590/S1677-55382012000100012 |
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Tsivian,Alexander Tsivian,Matvey Benjamin,Shalva Sidi,Ami A. |
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Tsivian,Alexander Tsivian,Matvey Benjamin,Shalva Sidi,Ami A. Simplified hemostatic technique during laparoscopic partial nephrectomy |
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Tsivian,Alexander Tsivian,Matvey Benjamin,Shalva Sidi,Ami A. |
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Tsivian,Alexander |
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Simplified hemostatic technique during laparoscopic partial nephrectomy |
title_short |
Simplified hemostatic technique during laparoscopic partial nephrectomy |
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Simplified hemostatic technique during laparoscopic partial nephrectomy |
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Simplified hemostatic technique during laparoscopic partial nephrectomy |
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Simplified hemostatic technique during laparoscopic partial nephrectomy |
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simplified hemostatic technique during laparoscopic partial nephrectomy |
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INTRODUCTION: Laparoscopic partial nephrectomy (LPN) has gained popularity in recent years, although it remains a challenging procedure. Herein we describe our technique of renal defect closure using sutures as the sole means of hemostasis during LPN. SURGICAL TECHNIQUE: The kidney is approached transperitoneally in a standard fashion. After the renal artery is clamped and the tumor has been excised, the defect is closed in two separate knot-free suture layers. The deep layer suture is continuous and involves deep parenchyma including the collecting system, if opened. The superficial layer suture approximates the margins of the defect using absorbable clips on one parenchymal edge only. No bolsters, glues or other additional hemostatic agents are used. RESULTS: At present this technique was applied in 34 patients. Tumor size ranged from 17-85 mm. Median warm ischemia time was 23 min (range 12-45) and estimated blood loss 55 mL (30-1000). There were no intraoperative complications or conversions to open surgery. No urine leaks or postoperative bleedings were observed. CONCLUSIONS: This simplified technique appears reliable and quick, and therefore may be attractive for many urologic surgeons. Furthermore, the avoidance of routine use of additional hemostatic maneuvers may provide an economical advantage to this approach with no compromise of the surgical outcome. |
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Sociedade Brasileira de Urologia |
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2012 |
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http://old.scielo.br/scielo.php?script=sci_arttext&pid=S1677-55382012000100012 |
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AT tsivianalexander simplifiedhemostatictechniqueduringlaparoscopicpartialnephrectomy AT tsivianmatvey simplifiedhemostatictechniqueduringlaparoscopicpartialnephrectomy AT benjaminshalva simplifiedhemostatictechniqueduringlaparoscopicpartialnephrectomy AT sidiamia simplifiedhemostatictechniqueduringlaparoscopicpartialnephrectomy |
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