Intraoperative Autotransfusion in Urologic Oncology

Klimberg, Ira

doi:10.1001/archsurg.1986.01400110118020

Cited by 73 publications

(16 citation statements)

References 3 publications

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“…It is time for surgeons to count, and be counted. It is generally accepted that the presence of seminal vesicle invasion (SVI) in a resected specimen is an unfavourable prognostic factor in prostate cancer [1][2][3]. SVI has been reported in 5-13.6% of recent radical prostatectomy specimens [4][5][6].…”

Section: Standardization Of Radical Cystectomymentioning

confidence: 99%

“…Survival after cystectomy is predicted by the pathological stage of the primary bladder tumour and nodes, as well as the quality of cystectomy [2]. Chemotherapy may improve the subsequent survival [3], but even with combined therapy the quality of surgery influences the outcome. For example, a subset analysis of a randomized, cooperative group trial of neoadjuvant chemotherapy plus cystectomy showed that the surgical factors of margin status, extent of node dissection, number of nodes resected and individual surgeon's experience (by training and volume) were independent predictors of overall survival [4].…”

Section: Introductionmentioning

confidence: 99%

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Red‐cell salvage in urological surgery

2004

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Section: Standardization Of Radical Cystectomymentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Red‐cell salvage in urological surgery

2004

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“…Complications associated with homologous cancer surgery, e.g. radical prostatectomy and cystectomy, has been reported [9][10][11]. We report our blood transfusion include viral hepatitis, alloimmunization, haemolytic and allergic reactions, and experience using IAT during radical cystectomy.…”

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confidence: 95%

Intra‐operative autotransfusion in radical cystectomy

Park¹,

Kojima²,

Tomoyoshi³

1997

British Journal of Urology

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Objective To assess the feasibility of intra‐operative autotransfusion (IAT) as a method of decreasing or avoiding homologous blood transfusion during radical cystectomy. Patients and methods IAT was performed in 10 patients with bladder cancer who underwent radical cystectomy. The patients were divided into two groups: group 1 consisted of six patients without and group 2 of four patients with pre‐deposited blood. Blood shed in the operative field was collected and processed with an IAT device. Results In group 1, the intra‐operative blood loss ranged from 1.08 to 2.67 L (mean 1.82) and homologous blood transfusion ranged from 0 to 1 L (mean 0.47). The amount of autologous blood processed and transfused by the IAT device ranged from 0.38 to 0.98 L (mean 0.64). Two patients did not require homologous blood transfusion. In group 2, the volume of pre‐deposited blood ranged from 0.8 to 1.2 L (mean 0.9). The intra‐operative blood loss ranged from 1.03 to 3.24 L (mean 1.8). The amount of processed autologous blood transfused ranged from 0.4 to 0.6 L (mean 0.45). None of the patients in group 2 required homologous blood transfusion. Conclusion Although there are theoretical risks with IAT, they were not substantiated by the clinical data. IAT seems to be a feasible method of reducing or avoiding homologous blood transfusion in radical cystectomy. These results suggest that IAT in combination with pre‐deposited blood will abolish the need for homologous blood transfusion during radical cystectomy.

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“…Salvage techniques allow the collection, washing, concentration and reinfusion of shed blood [8]. While they have been effective in reducing autologous transfusion requirements, variable perceptions about their acceptance in the JW community has led to the limited application [28].Our rationale for not using this technology was based on the potential concerns of spreading tumor cells to the patient's vasculature [29], as well as the ability of our renorrhaphy technique to minimize bleeding.…”

Section: Discussionmentioning

confidence: 99%

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Eun¹

2015

JURNOA

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Research ArticleAnother group in which BT utilization is limited is the Jehovah's Witness (JW) population. The JW religion is a Christianbased faith founded in the United States characterized by the avoidance of BT, even if it may lead to morbidity or mortality [10]. Because of this belief, many JW patients may experience difficulty in finding surgeons willing to perform elective major operations.Partial Nephrectomy (PN) has been recognized as the standard of care operation for the small renal mass (< 4cm) [11]. While PN has been heralded as a nephron-sparing surgical approach, the incidence of post-operative complications -including hemorrhage and pseudoaneurysm -may prevent widespread adoption [12]. One potential advantage of Robotic Partial Nephrectomy (RPN) is that it may mitigate the hemorrhagic complications and thus make this operation more accessible [13]. This could have particular applications in the JW population.We present the first published series of RPN in a group of JW patients. MethodsAfter proper internal review board approval, we prospectively maintained a database of JW patients undergoing RPN between 2010-2014. The procedures were performed by a single surgeon at two institutions. Preoperative optimization with a hematologist was sought on every procedure, as a part of the Bloodless Medicine program at our institution.All procedures were performed in a transperitoneal fashion. Intraoperative ultrasound was used to localize the tumor, and artery-only clamping was performed unless venous backbleeding was encountered. Tumor excision was performed using a standard technique, with cold scissors and gentle retraction.Renorrhaphy was performed using our innovation of the sliding-clip technique [14], which is unique to our institution. The suture consists of two V-LOC (Medtronic, Minneapolis, MN) sutures attached at the tails Figure 1. The first layer of closure is performed using the 3-0 V-LOC with a CV-23 needle, which is similar to a RV-1. Critical to this step is the approximation of the corticomedullary junction, as this tends to be the stronger layer. Also important in this step is the closure of any collecting Abstract Background: Recent interest in "bloodless" surgery places the urologic surgeon in a difficult position, especially as surgeries such as partial nephrectomy with an increased risk of bleeding, grow in popularity and the availability of blood for transfusion decreases. Jehovah's Witnesses are a religious group that refuses blood transfusion on religious grounds, which necessitates surgery in a setting where blood transfusion is not an option.

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Intraoperative Autotransfusion in Urologic Oncology

Cited by 73 publications

References 3 publications

Red‐cell salvage in urological surgery

Red‐cell salvage in urological surgery

Intra‐operative autotransfusion in radical cystectomy

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

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