Robotic surgery and hemostatic agents in partial nephrectomy: a high rate of success without vascular clamping

Abstract

Robot-assisted partial nephrectomy has been proposed as a technique to overcome technical challenges of laparoscopic partial nephrectomy. We prospectively collected and analyzed data from 31 patients who underwent robotic partial nephrectomy with systematic use of hemostatic agents, between February 2009 and October 2014. Thirty-three renal tumors were treated in 31 patients. There were no conversions to open surgery, intraoperative complications, or blood transfusions. The mean size of the resected tumors was 27 mm (median 20 mm, range 5-40 mm). Twenty-seven of 33 lesions (82%) did not require vascular clamping and therefore were treated in the absence of ischemia. All margins were negative. The high partial nephrectomy success rate without vascular clamping suggests that robotic nephron-sparing surgery with systematic use of hemostatic agents may be a safe, effective method to completely avoid ischemia in the treatment of selected renal masses.

Open Partial Nephrectomy without Ischemia

“…Morelli L. and coworkers in a clinical trial using Robotic surgery and hemostatic agents in partial nephrectomy lead to higher rate of success (82%) without vascular clamping and suggested RAPN as a technique to overcome technical challenges of LPN (20). We didn't have any technical challenge in…”

High‐Intensity Focused Ultrasonography and Radiofrequency Ablation of Renal Cell Carcinoma Arisen in Transplanted Kidneys: Single‐Center Experience With Long‐Term Follow‐Up and Review of Literature

“…Surgery has been considered the gold standard for the treatment of RCC of native kidneys, which nowadays may also be accomplished using robotic minimally invasive PN, and has showed in large series a very low rate of complications (only up to 7.4%), a low positive resection margin of 2.5%, and no compromised renal function.…”

Do Renal Tumor Characteristics Affect the Number of Hemostatic Agents Used During Partial Nephrectomy?

“…During PN, after the tumor is excised, the important step is to quickly control bleeding by providing a good hemostasis in order to see surgical margins clearly and to achieve reconstruction of the renal parenchyma in a shorter time. HAs have been in use for many years for the purpose of accelerating and facilitating the hemostasis stage in both the open, laparoscopic, and robotic types of PN (6)(7)(8)(9)(10)(11)(12)(13)(14). In a multicenter study conducted by Lang et al (6) Previous studies in the literature have shown the association between ischemia time and NSs such as RENAL., preoperative aspects and dimensions used for an anatomical, C-index, and diameter-axial-polar during PN (15,17,18,19).…”

“…HAs have been used in PN surgery for many years. It was stressed that these agents had potential benefits associated with decreasing complications, such as bleeding and urinary leakage, and shortening ischemia time in both laparoscopic and robotic surgery (8,9). Meanwhile, years of accumulated experience and advances in suture techniques called the hemostatic effect of these HAs into question.…”

“…Multicenter studies conducted in Europe and the United States have determined the rates of using at least one HA in OPN or LPN to be between 67.5% and 86% (6,7). Some of these agents facilitate hemostasis during surgery, while others contribute to renography by filling the parenchymal defect created by tumor excision in addition to facilitating hemostasis (5,8,9). On the other hand, other studies have stated that HA use did not cause a difference in the bleeding complication and could only have an effect in cases of minor bleeding (6,7).…”