A Review of Methods for Hemostasis and Renorrhaphy After Laparoscopic and Robot-assisted Laparoscopic Partial Nephrectomy

Rajan, Rajesh; Leveillee, Raymond J.

doi:10.1007/s11934-010-0107-7

Cited by 27 publications

(17 citation statements)

References 85 publications

(96 reference statements)

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“…This step includes a combination between suturing techniques and tissue sealants. [3031] The extent and methods of repair depends on the size and the depth of the defect and whether the collecting system is entered or not. Johnston et al ., recommended using hilar clamping if the lesion penetrates more than 5 mm into the kidney, and to apply fibrin glue with or without sutured bolster depending on opening of collecting system or injury to renal sinus.…”

Section: Introductionmentioning

confidence: 99%

Hemostasis in laparoscopic renal surgery

Hassouna

Manikandan

2012

Indian J Urol

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Hemorrhage is a potential risk at any step of laparoscopic nephrectomies (LNs). The advances in surgical equipment and tissue sealants have increased the safety and efficiency of performing LN and laparoscopic partial nephrectomy (LPN). However, hemostasis remains a major issue and there is still scope for further development to improve haemostatic techniques and devices. In this article a literature review of the current methods and techniques of hemostasis was carried out using the MEDLINE ®/PubMed® resources. The results of the review were categorized according to the three main operative steps: Dissection, control of renal pedicle and excision of the renal lesion.

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Section: Introductionmentioning

confidence: 99%

Hemostasis in laparoscopic renal surgery

Hassouna

Manikandan

2012

Indian J Urol

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“…It depends on efficient retraction of small vessels, appropriate clot formation, and effective occlusion of all bleeding points with intraluminal clot or extraluminal compression with sutures, clips, or staples. 31 Although several expected differences have been found among all tertiary care centres, tumour bed haemostasis has been preferably performed with interrupted and continuous sutures, while the utilization of hem-o-lok/titanium clips or argon laser represented less common techniques. Conversely, the utilization of haemostatic agents increased over time (p < 0.0001, Table 2), with predominantly use of tissue sealants agent, particularly during LPN and RAPN although their efficacy to reduce the risk of postoperative bleeding has not been proved yet.…”

Section: Discussionmentioning

confidence: 99%

A snapshot of nephron-sparing surgery in Italy: A prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project)

Schiavina¹,

Mari²,

Antonelli³

et al. 2015

European Journal of Surgical Oncology (EJSO)

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Introduction: Nephron-sparing surgery (NSS) has become the standard of care for the surgical management of small and clinically localized renal cell carcinoma (RCC). The conservative management of those RCCs is increasing over time. Aim of this study was to report a snapshot of the clinical, perioperative and oncological results after NSS for RCC in Italy. Results: Globally, 983 patients were evaluated. More recently, patients undergoing NSS were found to be significantly younger (p ¼ 0.05) than those surgically treated in the first study period, with a significantly higher rate of NSS with relative and imperative indication (p < 0.001). More recently, a higher percentage of procedures for cT1b or cT2 renal tumours was observed (p ¼ 0.02). Utilization rate of open partial nephrectomy (OPN) constantly decreased during years, laparoscopic partial nephrectomy (LPN) remained almost constant while robot-assisted partial nephrectomy (RAPN) increased. The rate of clampless NSS constantly increased over time. The use of at least one haemostatic agent has been significantly more adopted in the most recent surgical era (p < 0.001). Conclusions: The utilization rate of NSS in Italy is increasing, even in elective and more complex cases. RAPN has been progressively adopted, as well as the intraoperative utilization of haemostatic agents and the rate of clampless procedures.

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“…2(A)]; the destruction score was 45. A fibrous scar formed on the surface of the wound after 30 days; (6) in the alteration area, interstitial hemorrhages with the presence of hyaline in tubules (4), regressive changes in tubules (7). (B) 30d-massive nonspecific granulation in the alteration area (1), degenerative changes in tubules (2) and forming fibrous scar (3), nonspecific interstitial aggregates-possibly degrading agent (4), hemorrhages in the fibrous scar (5).…”

Section: Histopathological Featuresmentioning

confidence: 99%

“…[Color figure can be viewed in the online issue, which is available at wileyonlinelibrary.com.] (4), presence of hyaline in tubules (5), edema of proximal tubules in the vicinity of wound (6), interstitial hemorrhages (7). (B) 30d-cortex with fibrous scar on the wound surface (1), receding granulation tissue (2) due to regenerative and reparative processes (3), presence of hyaline in tubules (4), vasodilatation (5).…”

Section: Histopathological Featuresmentioning

confidence: 99%

Local tissue reaction after the application of topical hemostatic agents in a rat partial nephrectomy model

Chalupová

Suchý

Pražanová

et al. 2012

J Biomedical Materials Res

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Various hemostatics are used for renal surgical procedures. We investigated the hemostatic efficacy of cellulose derivatives on the model of partial nephrectomy in rats focusing on the local reaction of renal parenchyma. A total of 50 Wistar rats were divided into five groups of 10 animals each. Partial nephrectomy of the caudal pole without hilar vascular control was performed. Oxidized cellulose (OC), sodium salt of oxycellulose (OCN), carboxymethyl cellulose (CMC), dialdehyde cellulose (DAC), and gelatin-based hemostatic (C) were applied to the bleeding wounds. The time to hemostasis was monitored. Half of the animals were euthanized after 3 days, the second half 30 days from the experiment start date. The left kidney was excised and subjected to histopathological examination. The biochemical data was subjected to statistical analysis. The time to hemostasis in all groups was significantly less than in the C group (in OC p = 0.0057, OCN p = 0.0039, CMC and DAC p = 0.0001). In the C group, massive hemorrhages and necrosis did occur. In the OC and OCN groups, there were regenerative changes, a receding inflammatory reaction and hemorrhage. DAC caused an immune reaction and massive interstitial hemorrhages with biochemical signs of liver damage. Parenchyma in CMC revealed a reduction of necrosis and interstitial hemorrhages with regenerative processes. The most effective hemostatics were CMC and OC, achieving the best results both in the time to hemostasis, and for histopathological evaluation.

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A Review of Methods for Hemostasis and Renorrhaphy After Laparoscopic and Robot-assisted Laparoscopic Partial Nephrectomy

Cited by 27 publications

References 85 publications

Hemostasis in laparoscopic renal surgery

Hemostasis in laparoscopic renal surgery

A snapshot of nephron-sparing surgery in Italy: A prospective, multicenter report on clinical and perioperative outcomes (the RECORd 1 project)

Local tissue reaction after the application of topical hemostatic agents in a rat partial nephrectomy model

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