Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Abstract

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.