Laparoscopic Partial Nephrectomy in the Pig Model

McDougall, Elspeth M.; Clayman, Ralph V.; Chandhoke, Paramjit S.; Kerbl, Kurt; Stone, A.; Wick, Mark R.; Hicks, Marshall E.; Figenshau, Robert S.

doi:10.1016/s0022-5347(17)36465-0

Cited by 134 publications

(48 citation statements)

References 2 publications

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“…[1][2][3][4] During critical portions of the procedure, arterial clamping is routinely necessary to provide a relatively bloodless field for tumor dissection and to minimize intraoperative blood loss. However, the potential for ischemic damage to the remaining renal parenchyma remains a concern.…”

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confidence: 99%

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Benway

Baca

Bhayani

et al. 2009

Journal of Endourology

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Diaz, Dilmer L.; Maxwell, Keegan L.; Badwan, Khalid H.; Talcott, Michael R.; Liapis, Helen; Cabello, Jose M.; Venkatesh, Ramakrishna; and Figenshau, Robert S., ,"Selective versus nonselective arterial clamping during laparoscopic partial nephrectomy: Impact upon renal function in the setting of a solitary kidney in a porcine model." Journal of Endourology.23,7. 1127Endourology.23,7. -1133Endourology.23,7. . (2009 Introduction: Laparoscopic partial nephrectomy has emerged as a standard of care for small renal masses. Nevertheless, there remains concern over the potential for irreversible insult to the kidney as a result of exposure to warm ischemia. We aim to investigate the utility of selective segmental arterial clamping as a means to reduce the potential for ischemic damage to a solitary kidney during laparoscopic partial nephrectomy utilizing a porcine model. Materials and Methods: A total of 20 domestic swine were randomized into four equal groups. Each subject underwent laparoscopic radical nephrectomy to create the condition of a solitary kidney. On the contralateral side, a laparoscopic lower pole partial nephrectomy was performed, employing either selective or nonselective vascular clamping for either 60 or 90 minutes. Postoperatively, clinical status and serial serum studies were closely monitored for 1 week.Results: There were no intraoperative complications. The 90-minute nonselective clamping produced devastating effects, resulting in rapid deterioration into florid renal failure within 72 hours. The 60-minute nonselective clamping group experienced modest but significant rises in both blood urea nitrogen and creatinine. Both 60-and 90-minute selective clamping groups performed well, with no significant rises in creatinine over a 7-day period, and no instances of renal failure. Conclusions: Selective arterial clamping is a safe and feasible means of vascular control during laparoscopic partial nephrectomy. In the porcine model, selective clamping appears to improve functional outcomes during prolonged periods of warm ischemic insult. Prospective evaluation of the technique in humans is necessary to determine if selective arterial control confers long-term functional benefits in patients with limited renal reserve.

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Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Benway

Baca

Bhayani

et al. 2009

Journal of Endourology

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“…The double loop tourniquet technique consists of two U-loop strips of umbilical tape extending from a 17 Fr plastic sheath described by Gill et al [45] in a single LPN. McDougall et al [2] and Caddedu et al [46] have reported the use of a plastic cable tie for LPN in a pig model [2]. Compression with pledgeted sutures [47] and an Endoloop [48] have also been reported in pigs.…”

Section: Parenchymal Compressionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy – Current State of the Art

P¹,

Dason²,

Kapoor³

2012

Emerging Research and Treatments in Renal Cell Carcinoma

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“…Since the introduction of laparoscopic nephrectomy by Clayman in 1991 22 and the description of laparoscopic partial nephrectomy by McDougall in 1993, 21 minimally-invasive nephron-sparing renal surgery has essentially become the new standard of care for small renal masses. A natural extension of this technology has been the recent expansion of robotic surgery in this field.…”

Section: Robot-assisted Partial Nephrectomymentioning

confidence: 99%

Robot-assisted surgery: applications in urology

Pruthi¹

2010

OAJU

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Abstract:The past decade has seen a dramatic shift in the surgical management of certain urologic conditions with the advent of a robotic surgical platform. In fact, the surgical management of prostate cancer has seen the most dramatic shift, with the majority of cases now being performed robotically. Technical refinements over the years have led to improved outcomes regarding oncologic and functional results. Recently, robotic surgery has also been utilized for the surgical management of bladder cancer, renal cancer, and other benign conditions. As further experience is gained and longer-term outcomes are realized, robotic surgery will likely play an increasing role in the surgical management of many urologic conditions. Keywords: robot-assisted surgery, robotic surgery, cystectomy, prostatectomy, partial nephrectomy Technological advances continue to impact the modern practice of urology, none more so in recent years than the development of robotic surgery. Since the first publication of a series of patients undergoing robot-assisted radical prostatectomy in 2001, the field has seen a dramatic increase in the use of robotic surgery for urologic procedures. In fact, more than 60,000 robot-assisted radical prostatectomies were performed last year alone.The minimally-invasive nature of these procedures allows for better precision, decreased blood loss, shorter hospital stay, decreased morbidity, and shorter convalescence while preserving functional and oncologic outcomes. Additionally, the application of robotic surgery has spread beyond radical prostatectomy to include radical cystectomy, nephrectomy, partial nephrectomy, adrenalectomy, and other upper urinary tract surgery (pyeloplasty, ureteral reimplant, etc.). Robotic surgery has even seen dramatic growth in pediatric urologic applications.In this review, we will attempt to highlight robotic surgical applications to various urologic procedures and discuss the recent advances in these procedures. Robot-assisted radical prostatectomyThe surgical treatment of prostate cancer has seen a dramatic shift over the past decade. Minimally-invasive approaches to prostate surgery were slow to gain a foothold until the development of a robotic surgical platform. Prior to this development, laparoscopic radical prostatectomy was performed, but only by advanced laparoscopic surgeons. This method was undoubtedly limited by a steep learning curve and the arduous tasks of the procedure, including intracorporeal suturing. The robotic platform takes

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Laparoscopic Partial Nephrectomy in the Pig Model

Cited by 134 publications

References 2 publications

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Selective Versus Nonselective Arterial Clamping During Laparoscopic Partial Nephrectomy: Impact upon Renal Function in the Setting of a Solitary Kidney in a Porcine Model

Laparoscopic Partial Nephrectomy – Current State of the Art

Robot-assisted surgery: applications in urology

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