Robotic Partial Nephrectomy with Sliding-Clip Renorrhaphy: Technique and Outcomes

Benway, Brian M.; Wang, Agnes J.; Cabello, José M.; Bhayani, Sam B.

doi:10.1016/j.eururo.2008.12.028

Cited by 316 publications

(187 citation statements)

References 29 publications

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“…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.…”

Section: Methodsmentioning

confidence: 99%

“…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.…”

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confidence: 99%

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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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Section: Methodsmentioning

confidence: 99%

mentioning

confidence: 99%

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Eun¹

2015

JURNOA

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“…10,11 We used a medial camera port placement, transperitoneal approach, a three arm-technique, hilar clamping for tumor excision under warm ischemia, and renal reconstruction using the sliding clip renorrhaphy technique. 12 All RPN procedures using the robotic ultrasound probe were carried out by an experienced robotic kidney surgeon (CR) and a single experienced robotic assistant on 22 consecutive patients between November 2010 and March 2011. All patients had at least 1 year of follow up.…”

Section: Methodsmentioning

confidence: 99%

Robotic ultrasound probe for tumor identification in robotic partial nephrectomy: Initial series and outcomes

et al. 2012

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Objectives: Accurate tumor identification during partial nephrectomy is essential for successful tumor control. Intraoperative laparoscopic ultrasonography is useful for tumor localization, but the ultrasound probe is controlled by the assistant rather than the surgeon. We evaluated our initial experience using a robotic ultrasound probe that is controlled by the console surgeon. Methods: Partial nephrectomy was carried out in 22 consecutive patients between November 2010 and March 2011. A robotic ultrasound probe under console surgeon control was used in all the cases. All patients had at least 1 year follow up. Results: Mean patient age was 59 years and mean tumor size was 2.7 cm. There were six hilar tumors (27%) and 21 (95%) endophytic tumors. Mean R.E.N.A.L. nephrometry score was 6.9 (range 6-9). Mean operative time was 205.7 min and mean warm ischemia time was 17.9 min (range 6-28 min). All patients had negative tumor margins and were free of disease recurrence at a mean follow up of 13 months. Conclusion: The use of a robotic ultrasound probe during partial nephrectomy allows the surgeon to optimize tumor identification with maximal autonomy, and to benefit from the precision and articulation of the robotic instrument during this key step of the partial nephrectomy procedure.

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“…Median operating time was 270 minutes, and median blood loss was 150 mL. Median WIT was 20 (11)(12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29) minutes and median hospital stay was 3 days. One patient developed postoperative hemorrhage and pulmonary embolism.…”

Section: Less/notes Pnmentioning

confidence: 99%

“…21 Taut suture line tension achieved with this approach was thought to possibly be useful in preventing postoperative pseudoaneurysms and/or urine leaks. Sliding clip renorrhaphy is another innovation, first described by Benway et al 22 In this technique, a Hem-o-lock clip (Teleflex Medical, Research Triangle Park, NC, USA) is loaded on either end of the renorrhaphy sutures that are placed across the resection bed through the renal capsule. The clips are then slid onto the capsule to achieve capsular compression.…”

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confidence: 99%

Laparoscopic partial nephrectomy: state of the art review

Faiena¹,

Han²,

Olweny³

2014

OAS

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Introduction:The surgical management of small renal masses (,4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods:We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms "laparoscopic partial nephrectomy", "robotassisted partial nephrectomy", "robotic partial nephrectomy", and "laparoscopic partial nephrectomy oncologic and functional outcomes". Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN.

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Robotic Partial Nephrectomy with Sliding-Clip Renorrhaphy: Technique and Outcomes

Cited by 316 publications

References 29 publications

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Robotic Partial Nephrectomy in a Jehovah’s Witness Population

Robotic ultrasound probe for tumor identification in robotic partial nephrectomy: Initial series and outcomes

Laparoscopic partial nephrectomy: state of the art review

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