Hemostasis in laparoscopic renal surgery

Abstract

Hemorrhage is a potential risk at any step of laparoscopic nephrectomies (LNs). The advances in surgical equipment and tissue sealants have increased the safety and efficiency of performing LN and laparoscopic partial nephrectomy (LPN). However, hemostasis remains a major issue and there is still scope for further development to improve haemostatic techniques and devices. In this article a literature review of the current methods and techniques of hemostasis was carried out using the MEDLINE ®/PubMed® resources. The results of the review were categorized according to the three main operative steps: Dissection, control of renal pedicle and excision of the renal lesion.

A novel approach to assess minimally invasive surgical device failure utilizing adverse event outcome severity and design complexity.

“…Despite the presence of user error, the recall reasons that were consistent with the adverse event outcomes and the corresponding number of units recalled indicated that device based failures also share responsibility. The failure modes identified and the phases in which they occurred were consistent with those outlined in scientific literature (Deng, Meng et al 2002, Champion and Williams 2003, Hamilton, Sims et al 2003, Marshall, Srivastava et al 2003, Brown and Woo 2004, Govekar, Robinson et al 2011, Noble, Smart et al 2011, Hassouna and Manikandan 2012, Lyons and Law 2013, Mansour, El-Nashar et al 2014, Overbey, Townsend et al 2015. Various failures modes were uncommon, yet resulted in severe outcomes when they did occur.…”

“…Similarly, the two most common mechanisms of endoscopic stapler failure during laparoscopic renal surgery were determined to be inadequate staple lines and failure to release from tissue, which resulted in a high percentage of severe hemorrhage and conversions to open surgery (Hassouna and Manikandan 2012). Outcomes of gastric bypass surgery have shown staple line failures and anastomotic leaks to be a major cause of patient morbidity and death (Champion and Williams 2003, Hamilton, Sims et al 2003, Marshall, Srivastava et al 2003.…”

“…Further, it was stated that the two most common mechanisms of failure found in the investigation were inadequate staple lines and device failure to release from tissue, which result in a relatively high percentage of severe hemorrhage and open conversion during laparoscopic renal surgery (Hassouna and Manikandan 2012). These consequences heavily affect staple line integrity, which is an essential aspect of endoscopic stapling given that failure many times causes intra-operative and post-operative leaks, thus compromising a patient's recovery, health, and safety.…”

“…Efficient searches of the database must be approached systematically as described in the study by Gupta and Pidgeon (Gupta and Pidgeon 2016 formation to be the most common and fatal aspects of device error (Deng, Meng et al 2002). A study on hemostasis in laparoscopic renal surgery indicated that endoscopic staplers had the highest risk of malfunctioning (Hassouna and Manikandan 2012).…”

“…wide-ranging open and MIS procedures (Deng, Meng et al 2002, Janetschek, Bagheri et al 2003, Belli, Fantini et al 2006, Robert, Poncet et al 2011, Hassouna and Manikandan 2012, Kwazneski, Six et al 2012. Endoscopic staplers deploy either purely mechanical or powered mechanisms to simultaneously staple and transect target tissue during the firing sequence.…”