Complications of Laparoscopic Partial Nephrectomy in 200 Cases

Ramani, Anup P.; Desai, Mihir; Steinberg, Andrew P.; Ng, Christopher; Abreu, Sidney C.; Kaouk, Jihad; Finelli, Antonio; Novick, Andrew C.; Gill, Inderbir S.

doi:10.1097/01.ju.0000147177.20458.73

Cited by 297 publications

(157 citation statements)

References 16 publications

Supporting

Mentioning

139

Contrasting

Unclassified

Order By: Relevance

“…While intraoperative bleeding from the tumour resection bed is usually recognized and can be addressed by oversewing the parenchyma or the bleeding vessel, recognizing postoperative haemorrhage can be more challenging, especially when patients present days or weeks after surgery. Overall, postoperative haemorrhage after LPN has been reported to be 4.2-6% [8,9]. Delayed postoperative haemorrhage has not been well defined separately but appears to occur in 1.2% of small tumour cases and in up to 7.5% of more complex cases involving centrally located tumours [4,6,11,12].…”

Section: Discussionmentioning

confidence: 99%

“…Review of the literature showed that delayed bleeding after LPN was most often associated with RAP. To the best of our knowledge, there are eight case reports describing a total of 11 cases as well as four case series describing an additional 22 cases of delayed haemorrhage after LPN secondary to RAP (Table 3 [ 4,8,[13][14][15][16][17][18][19][20][21][22][23]). Additionally, one series by Ramani et al .…”

Section: Gross Hematuria ≥ 7 Daysmentioning

confidence: 99%

“…Bleeding, one of the most serious complications after LPN, ranges from 4.2 to 6% including both immediate postoperative and delayed haemorrhage. The data suggests patients undergoing LPN for centrally located tumours are at greater risk of bleeding [4,8,9]. A small number of studies have focused on defining delayed haemorrhage after LPN or OPN.…”

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

et al. 2010

View full text Add to dashboard Cite

Study Type – Therapy (case series)  Level of Evidence 4 What’s known on the subject? and What does the study add? Delayed haemorrhage has not been well defined in the literature, clinical presentation has not been well described and treatment algorithms are lacking. From our experience we have shown that patients presenting with delayed bleeding after laparoscopic partial nephrectomy will need definitive rather than conservative treatment and angiographic findings demonstrate definitive lesions in all cases. Potential benefits include faster diagnosis and initiation of definitive treatment (angiography with embolization), avoiding repeat computed tomography imaging as it adds little in such patients and reducing need for prolonged hospitalization. OBJECTIVES • To determine the frequency of delayed postoperative haemorrhage requiring selective angioembolization (SAE) after laparoscopic partial nephrectomy (LPN). • To describe the clinical presentation and characterize the angiographic findings encountered in this setting. PATIENTS AND METHODS • Prospective data from 640 LPNs performed between August 1993 and May 2009 were retrospectively analyzed, from which patients with delayed postoperative haemorrhage (defined as ‘gross haematuria ≥7 days postoperatively that persists for more than 24 h’) and requiring SAE were identified. • Clinicopathological, preoperative and perioperative factors were reviewed. • Selective catheterization and angiography of the renal artery was performed for persistent gross haematuria and for haemodynamic instability associated with a significant drop in haematocrit level. • Arteries feeding the bleeding site were identified and embolized with endovascular coils. RESULTS • Patients presented with delayed haemorrhage between 7 and 30 days after surgery. SAE was required in 13 patients (2%) for delayed postoperative bleeding. • Of the 640 LPNs, 68 (10.6%) were performed without hilar occlusion (‘off‐clamp’) of whom one (1.5%) had a delayed haemorrhage, which was successfully embolized. • For patients with and without delayed haemorrhage after LPN, the mean tumour size was 2.7 cm and 3.3 cm (P= 0.31), the mean warm ischaemia time was 28.2 min and 14.3 min (P < 0.001), and the mean estimated blood loss 403.8 mL and 308.2 mL (P= 0.26), respectively. • Percutaneous angiography showed renal artery pseudoaneurysm in 10 patients and arterial contrast extravasation in three patients, two of whom also had an arteriovenous fistula. • Following embolization, creatinine levels remained stable in all patients. CONCLUSIONS • Clinically significant delayed postoperative bleeding after LPN occurs in a small percentage of patients. • Angiography will accurately make the diagnosis of RAP or AVF and SAE is safe and effective procedure that allows for preservation of renal function.

show abstract

Section: Discussionmentioning

confidence: 99%

Section: Gross Hematuria ≥ 7 Daysmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Delayed haemorrhage after laparoscopic partial nephrectomy: frequency and angiographic findings

et al. 2010

View full text Add to dashboard Cite

show abstract

“…FloSeal can be injected through a single laparoscopic port with a short application time and does not require a completely dry surgical field to be effective. Disadvantages of FloSeal include cost, possible allergic reactions and potential transmission of prion diseases (22). In the present study, FloSeal was used as single hemostatic agent in all the patients.…”

Section: Discussionmentioning

confidence: 99%

“…Previous studies described an association between the depth of tumor invasion and rate of hemorrhage. Ramani et al (22) investigated complications associated with LPN and showed that 53% of 19 patients requiring transfusion due to hemorrhage had deep tumors. In this study, the FloSeal group tended toward significantly fewer hemorrhagic complications although the depth of tumor invasion was higher.…”

Section: Discussionmentioning

confidence: 99%