Novel Technique of Knotless Hemostatic Renal Parenchymal Suture Repair During Laparoscopic Partial Nephrectomy

Canales, Benjamin K.; Lynch, Alexandria; Fernandes, Eduardo; Anderson, J. Kyle; Ramani, Anup P.

doi:10.1016/j.urology.2007.04.031

Cited by 36 publications

(22 citation statements)

References 3 publications

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“…The relatively large footprint of the Hem-O-Lock clip allows for the tension placed on the closure to be distributed over a greater surface area, a property also suggested by Canales et al 12 In addition, the ease of sliding the Hem-O-Lock clips over the suture material prevents snagging on the suture, which could cause the surgeon to overcompensate and overshoot the desired tension. A sliding-clip technique affords the surgeon precise control over the tension of the renorrhaphy at all times, even allowing for adjustment of the tension if necessary.…”

Section: Discussionmentioning

confidence: 95%

“…7,8 Regardless of the approach, the renorrhaphy remains one of the most technically challenging portions of the case, especially under the time constraints of warm ischemia. 5,8 To address this challenge, alternatives to traditional tied closures have been introduced 6,[9][10][11][12] ; however, many of these techniques rely upon a skilled assistant working with angles that at times are less-than-ideal. 10,13,14 Recently, we reported our refined technique for renal reconstruction, which is distinguished from other techniques by the use of sliding clips that are under the control of the surgeon at the console, [15][16][17] with minimal use of bolsters and hemostatic agents.…”

mentioning

confidence: 99%

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Sliding-Clip Renorrhaphy Provides Superior Closing Tension During Robot-Assisted Partial Nephrectomy

Benway

Cabello²,

Figenshau³

et al. 2010

Journal of Endourology

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Benway, Brian M.; Cabello, Jose M.; Figenshau, Robert S.; and Bhayani, Sam B., ,"Sliding-clip renorrhaphy provides superior closing tension during robot-assisted partial nephrectomy." Journal of Endourology.24,4. 605-608. (2010 AbstractObjective: Recently, our institution refined a technique for robot-assisted renorrhaphy utilizing sliding Weck Hem-O-Lock clips, which are tightened by the surgeon seated at the console and locked into place with a LapraTy clip. In addition to the relative ease of implementation, we believe that our technique also provides a superior strength of closure over other commonly used techniques. Methods: An in vivo porcine model was used to compare a sliding-clip technique against an assistant-placed LapraTy-only closure, and a surgeon-placed simple suture closure. A force gauge was used to record the maximum tension that could be applied during each closure method before the suture ripped through the renal parenchyma, thus illustrating the relative strength of each closure. Results: The simple suture closure performed relatively poorly, ripping through parenchyma at a mean force of 11.3 N. The LapraTy-only method allowed a maximum applicable mean force of 16.7 N. The sliding Weck clip with a LapraTy bolster provided the tightest closure, allowing for a mean force of 32.7 N before ripping through parenchyma. Statistical analysis reveals that a sliding-clip technique provides a significantly tighter closure than both of the other tested methods. Conclusion: A sliding-clip technique allows for more tension to be safely applied to the closure of a partial nephrectomy defect than other commonly used methods. We believe that this is primarily attributable to the larger footprint of the Hem-O-Lock clip, which allows for the tension to be distributed over a greater surface area. The LapraTy then ensures the security of the closure by holding the Weck clip in place. Further studies are necessary to determine if this increased tension translates into appreciably better hemostasis.

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Section: Discussionmentioning

confidence: 95%

mentioning

confidence: 99%

Sliding-Clip Renorrhaphy Provides Superior Closing Tension During Robot-Assisted Partial Nephrectomy

Benway

Cabello²,

Figenshau³

et al. 2010

Journal of Endourology

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“…In an attempt to simplify the procedures, continued innovations in suture designs have been undertaken. Canales et al 12 have described a relatively simple technique by substituting Hem-o-lok clips for knot-tying, which significantly reduces the complexity of suturing. On this basis, Benway et al 7 introduced sliding clip renorrhaphy, which is distinguished by sliding the clip toward the kidney.…”

Section: Discussionmentioning

confidence: 99%

The Use of Self-Retaining Barbed Suture Preserves Superior Renal Function During Laparoscopic Partial Nephrectomy: A PADUA Score Matched Comparison

Chen

et al. 2015

Journal of Laparoendoscopic & Advanced Surgical Techniques

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“…A similar laparoscopic technique has been reported by Canales and colleagues. 1 We also place Lapra-Ty clips as well to secure the Weck clips.…”

Section: Techniquementioning

confidence: 99%

Robotic Renal Hilar Control and Robotic Clip Placement for Partial Nephrectomy

Figenshau

Bhayani

Venkatesh

et al. 2008

Journal of Endourology

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We demonstrate two techniques in this video clip that can be used when performing robotic-assisted laparoscopic partial nephrectomy. First, we use the fourth arm of the robot with a long-tip grasper to occlude the renal artery during the resection of the mass. Second, we show a novel method for securing the mattress sutures when performing the repair of the kidney. Both maneuvers help to increase the safety of the procedure and decrease the warm ischemia time to the kidney. 2657

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Novel Technique of Knotless Hemostatic Renal Parenchymal Suture Repair During Laparoscopic Partial Nephrectomy

Cited by 36 publications

References 3 publications

Sliding-Clip Renorrhaphy Provides Superior Closing Tension During Robot-Assisted Partial Nephrectomy

Sliding-Clip Renorrhaphy Provides Superior Closing Tension During Robot-Assisted Partial Nephrectomy

The Use of Self-Retaining Barbed Suture Preserves Superior Renal Function During Laparoscopic Partial Nephrectomy: A PADUA Score Matched Comparison

Robotic Renal Hilar Control and Robotic Clip Placement for Partial Nephrectomy

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