Fibrin Glue v Sutured Bolster: Lessons Learned During 100 Laparoscopic Partial Nephrectomies

Johnston, William K.; Montgomery, Jeffrey S.; Seifman, Brian; Hollenbeck, Brent K.; Wolf, J. Stuart

doi:10.1097/01.ju.0000162041.64143.08

Cited by 67 publications

(41 citation statements)

References 16 publications

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“…The localization of the tumour was defined as endophytic if more than 5 mm of the tumour was located in the renal parenchyma consistent with the Johntson classification. 12 …”

Section: Data Collection and Patient Selectionmentioning

confidence: 99%

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Pouliot

Imbeault

Shuch

et al. 2013

CUAJ

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Background: Partial nephrectomy (PN) is now the gold standard for the surgical treatment of small renal masses. We evaluated the effect of WIT and other factors on RDF assessed by preoperative and postoperative renal scintigraphy. Methods: Between 2003 and 2008, 182 consecutive laparoscopic PN (LPN) were performed in an academic centre. Among those, 56 had mercaptoacetyl triglycine (MAG3) lasix renal scintigraphy preoperatively and postoperatively. Results: Medians for age, preoperative estimated glomerular filtration rate and computed tomography scan tumour size were 62 years, 82 mL/min/1.73m 2 and 26 mm, respectively. Median WIT and preoperative RDF were 30 minutes and 50%, respectively. Median loss of RDF after surgery was 14%. Linear regression curves showed that loss in RDF rate was 0.2% per minute when WIT was <30 minutes and 0.7% per minute when WIT was ≥30 minutes. In multivariate analysis, length of WIT and endophytic tumour location were associated with a statistically significant loss of RDF (p < 0.05), but only in the group who experienced >30 minutes of WIT. Interpretation: Our results suggest that the factors associated with loss of RDF are not the same before and after 30 minutes of WIT and that the rate of loss in RDF increases after 30 minutes. Since, the effect of WIT is small up to 30 minutes, we believe that surgery should focus on limiting the resection of normal parenchyma and to ensure negative margins and hemostasis, rather than on premature unclamping.

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“…The localization of the tumour was defined as endophytic if more than 5 mm of the tumour was located in the renal parenchyma consistent with the Johntson classification. 12 …”

Section: Data Collection and Patient Selectionmentioning

confidence: 99%

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Pouliot

Imbeault

Shuch

et al. 2013

CUAJ

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“…While other topical agents have demonstrated hemostatic proficiency in human LPN situations, the potential side effects of these other agents must be considered. 8,9,11,16 Antifibrinolytics, such as aminocaproic acid, tranexamic acid, and aprotinin, work by binding plasminogen and interfering with the subsequent conversion to plasmin. Plasmin breaks down fibrin clots into fibrin degradation products, impairing hemostasis.…”

Section: Humphreys Et Al 1378mentioning

confidence: 99%

“…Fibrin glue, microfiber hemostatic collagen, intercorporal suture techniques, argon beam coagulation, monopolar and bipolar electrocautery, laser and tissue welding, gelatin matrices, granular mineral hemostatic agents, hydrogels, and glutaraldehyde mixtures have all been used to achieve laparoscopic hemostasis. [7][8][9][10][11][12] Each has a unique risk and benefit profile as well as potential side effects. The ideal hemostatic agent would be nonimmunogenic, inexpensive, readily available, easy to deploy, and biodegradable, with no residual radiographic signature.…”

Section: Introductionmentioning

confidence: 99%

Renal Injury and the Application of Polysaccharide Hemospheres: A Laparoscopic Experimental Model

Humphreys

Lingeman

Terry

et al. 2008

Journal of Endourology

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Background and Purpose: Microporous polysaccharide hemospheres (MPH) are hemostatic beads engineered from purified plant starch. MPH accelerates the natural clotting cascade by concentrating clotting factors and proteins on their surface while absorbing aqueous and low molecular weight components from blood. The purpose of this study was to determine the efficacy of MPH in achieving hemostasis in the setting of laparoscopic renal injury. Materials and Methods:In four domestic pigs, 16 laparoscopic renal trocar injuries were created (8 each of 12 and 5 mm). A standard hand-assisted laparoscopic approach was used to each kidney so that two lesions per kidney were randomly created. MPH was applied to each treatment lesion with light pressure maintained for 60 seconds. Four of the 16 lesions, two each of 12 and 5 mm, were allowed to bleed as controls. Hemostasis was defined as no active bleeding or oozing. The animals were sacrificed at the conclusion of the procedure. Results: The mean time to hemostasis for the 12-mm MPH and control lesions was 196.2 Ϯ 53.3 and 372.0 Ϯ 225.6 seconds, while the average blood loss was 8.3 Ϯ 3.7 and 12.0 Ϯ 4.9 g, respectively. For the 5-mm MPH and control lesions, the average time to hemostasis was 100.2 Ϯ 24.8 and 247.0 Ϯ 134.4 seconds, while the average blood loss was 8.3 Ϯ 3.8 and 9.0 Ϯ 0.7 g, respectively. The median number of applications of the MPH for the 5-and 12-mm injuries was 1 and 2, respectively. Conclusions: MPH provided a rapid and effective means of hemostasis for laparoscopic renal parenchymal injuries in this model. Additional evaluation is warranted, however, before general application is advisable.

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“…The procedure was performed using HALS before the development of our tailored approach in two patients, 10,11 whereas the other five underwent surgery after our treatment selection criteria. Briefly, location of the tumor determines the laparoscopic approach, depth of penetration into the renal parenchyma determines whether hilar clamping is utilized, and proximity of the resection to the renal sinus or collecting system determines management of the tumor bed.…”

Section: Methodsmentioning

confidence: 99%

“…5,6 There have been reports from two institutions of LPN for multiple ipsilateral renal tumors that provide early data on the potential viability of LPN as an approach to treating multifocal ipsilateral disease. [7][8][9] We present our experience with managing multiple synchronous ipsilateral renal tumors utilizing our approach to LPN that, as previously described, 10,11 is tailored to tumor characteristics.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy for Multiple Ipsilateral Renal Tumors Using a Tailored Surgical Approach

Flum

Wolf²

2010

Journal of Endourology

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Background and Purpose: Laparoscopic partial nephrectomy (LPN) is safe and effective for solitary renal masses, but its application to multiple ipsilateral renal tumors has been reported infrequently. We review our experience with LPN for multiple ipsilateral renal tumors to assess its role in current practice. Materials and Methods: We have managed seven patients with multiple ipsilateral renal tumors with LPN. Of the patients, four had an imperative indication for nephron-sparing surgery. Results: Among the 16 tumors resected, with a mean size of 2.1 cm, 9 (in five patients) were renal cell carcinoma on final pathology. LPN was performed without hilar clamping in four patients (no-clamp group), and with hilar clamping and a sutured bolster in three patients (clamp-suture group). The no-clamp group had a lower mean operative time than the clamp-suture group (185 vs. 225 minutes), similar mean estimated blood loss (363 vs. 417 mL), and shorter hospital stay (1.8 vs. 3 days). The only complication was an intraoperative hemorrhage necessitating blood transfusion, and there was one focal-positive margin, both in patients in the clamp-suture group. Among the five patients with cancer, there have been no local recurrences or metastases during a mean radiographic follow-up of 48 months. Conclusions: LPN, with a tailored approach that spares some patients from renal ischemia, appears to be safe and effective in this small series of selected patients with multiple ipsilateral renal tumors.

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Fibrin Glue v Sutured Bolster: Lessons Learned During 100 Laparoscopic Partial Nephrectomies

Abstract: LPN with closure using fibrin glue products provides adequate hemostasis when the CS or renal sinus is not entered. When the CS or renal sinus is entered, a sutured bolster is recommended.

Cited by 67 publications

References 16 publications

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Multivariate analysis of the factors involved in loss of renal differential function after laparoscopic partial nephrectomy: a role for warm ischemia time

Renal Injury and the Application of Polysaccharide Hemospheres: A Laparoscopic Experimental Model

Laparoscopic Partial Nephrectomy for Multiple Ipsilateral Renal Tumors Using a Tailored Surgical Approach

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