Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

Huber, Johannes; Pahernik, Sascha; Hallscheidt, Peter; Sommer, Christof M.; Hatiboglu, Gencay; Haferkamp, Axel; Hohenfellner, Markus

doi:10.1111/j.1464-410x.2010.09345.x

Cited by 13 publications

(2 citation statements)

References 25 publications

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“…Huber et al . [23] evaluated bleeding complications after open nephron sparing surgery in 196 consecutive cases. They used as a criterion for haemorrhage a persistent decreasing haematocrit that could not be accounted for by intraoperative blood loss, requiring the transfusion of at least two units of blood.…”

Section: Discussionmentioning

confidence: 99%

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

et al. 2011

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Study Type – Therapy (case series) Level of Evidence 4 What’s known on the subject? and What does the study add? Although laparoscopic excision of ipsllateral multifocal renal tumours is feasible, the average warm ischemia time is prolonged. Robotic partial nephrectomy in this subset of patients using blunt dissection to enucleate the tumour is feasible and safe. This study demonstrates further that robot‐assisted partial nephrectomy with a small margin of normal tissue is feasible and safe with an acceptable range of warm ischemia time in patients with sporadic ipsilateral multifocal renal tumours. This study also suggest that robotic partial nephrectomy for this particular group of patients may better preserve renal function compared to laparoscopic approach, however this needs to be confirmed with prospective comparative studies. OBJECTIVE • To report our short‐term results of robot‐assisted partial nephrectomy for treating sporadic multiple ipsilateral renal tumours. METHODS • Over a 3‐year period, eight patients with two or more ipsilateral renal masses underwent nine robotic partial nephrectomies in our institution. • We evaluated the PADUA and R.E.N.A.L. nephrometry scores, intraoperative outcomes, histopathological characteristics, complications according to Clavien classification and renal function outcomes. RESULTS • In total, 19 tumours were removed from eight patients in nine procedures. Mean operative time was 199 ± 47 min (median 200; range 150–300). Mean size of the dominant lesion was 3.0 ± 1.1 cm (2.7; 1.6–4.8) and overall mean tumour size was 2.2 ± 1.2 cm (1.9; 0.4–4.8). Mean number of tumours removed per patient was 2.4. • Median PADUA and R.E.N.A.L. scores were 7 and 6 (with the predominance of an anterior, non‐hilar position), respectively. • Excluding the six off‐clamp resected tumours, the mean warm ischaemia time was 21 ± 9.2 min (21; 10–35). Mean estimated blood loss was 250 ± 154 mL (200; 100–500) and no patient required transfusion. There were no intraoperative complications or conversion to open surgery. One patient had atrial fibrillation, resolved with anti‐arrhythmic drugs. Mean length of stay was 4.2 ± 0.97 days. • Sixteen of the nineteen tumours were malignant, most of papillary type and Fuhrman grade II. • The mean decrease in glomerular filtration rate was 4%, with a mean follow‐up of 14 months. CONCLUSIONS • Robotic partial nephrectomy for sporadic ipsilateral multifocal renal tumours is feasible and safe. • Off‐clamp resection of multiple tumours can also be safely performed in carefully selected lesions.

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Section: Discussionmentioning

confidence: 99%

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

et al. 2011

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“…The use of partial nephrectomy (PN) for the treatment of RCC has dramatically increased over the past decade, especially for small renal tumours, but also more recently for complex lesions . Haemorrhagic complications are a major concern after PN, and have been reported in 5–10% of patients . The postoperative bleeding risk is mostly related to the presence of pseudoaneurysm (PA), typically occurring within the first 14 days after PN .…”

Section: Introductionmentioning

confidence: 99%

Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

et al. 2018

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ObjectiveTo assess the clinical utility of systematic Doppler ultrasonography (DUS) after robot-assisted partial nephrectomy (PN) for the detection of renal artery pseudoaneurysm (PA) and to allow pre-emptive arterial embolization to reduce the postoperative bleeding risk. Materials and MethodsA retrospective study was conducted including all consecutive patients treated with robot-assisted PN for renal tumours between 2015 and 2017. Every patient underwent renal DUS in the early postoperative period. The presence of PA, arteriovenous malformation or collection on the DUS, as well as the incidence of haemorrhagic complications and need for transfusion/embolization were assessed. ResultsEighty-three patients were included, with a median (range) age of 58 (19-80) years. The median (range) follow-up was 5 (1-30) months. The mean (AESD) tumour size was 31 (AE13.1) mm, the median (range) RENAL nephrometry score was 6 (4-11), and the mean (AESD) warm ischaemia time was 22 (AE7) min. A haemostatic agent was used in 12 patients (14.5%). No patient encountered haemorrhagic complications postoperatively, and no patient required transfusion. The median (interquartile range) time to DUS postoperatively was 7 (6-8) days. DUS revealed one asymptomatic PA (1.2%), which was treated with pre-emptive embolization. This was the only patient who encountered a Clavien grade III complication, while 20 patients (24%) had a complication grade I/II. ConclusionsNo haemorrhagic complications occurred in the present study population, although one asymptomatic PA was found. It was diagnosed early with DUS, allowing pre-emptive management with embolization. These results suggest the potential clinical utility of early postoperative DUS in order to screen for PA to reduce the risk of post-PN haemorrhagic complications.

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Genitourinary Interventions

Pua¹,

Solomon²

2012

Atlas of Genitourinary Oncological Imaging

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Risk factors and clinical management of haemorrhage after open nephron‐sparing surgery

Cited by 13 publications

References 25 publications

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

Robot‐assisted partial nephrectomy for sporadic ipsilateral multifocal renal tumours

Is postoperative Doppler ultrasonography useful for the early detection of asymptomatic pseudoaneurysm and prevention of haemorrhagic complications after partial nephrectomy?

Genitourinary Interventions

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