1214 TEMPORARY TARGETED HEMOSTASIS USING A REVERSE THERMOSENSITIVE POLYMER TO FACILITATE BLOODLESS PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy1 Apr 20111214 TEMPORARY TARGETED HEMOSTASIS USING A REVERSE THERMOSENSITIVE POLYMER TO FACILITATE BLOODLESS PARTIAL NEPHRECTOMY Niall Harty, Spencer Kozinn, Jessica DeLong, Ali Moinzadeh, Sebastian Flacke, James Benn, John Libertino, and Peter Madras Niall HartyNiall Harty Burlington, MA More articles by this author , Spencer KozinnSpencer Kozinn Burlington, MA More articles by this author , Jessica DeLongJessica DeLong Burlington, MA More articles by this author , Ali MoinzadehAli Moinzadeh Burlington, MA More articles by this author , Sebastian FlackeSebastian Flacke Burlington, MA More articles by this author , James BennJames Benn Woburn, MA More articles by this author , John LibertinoJohn Libertino Burlington, MA More articles by this author , and Peter MadrasPeter Madras Burlington, MA More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.870AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Previous work has demonstrated that Lumagel™, a non-toxic, non-ionic polymer with reverse thermosensitive properties, may be used to obtain a bloodless operative field for robotic partial nephrectomy in a porcine model. We extend this work to laparoscopic and open partial nephrectomy, in which we obtain targeted renal ischemia for resection while allowing normal perfusion to the remaining kidney. We adapt our technique to allow main renal artery occlusion and compare polymer occlusion to clamping in this setting. To determine the role of Lumagel™ in larger renal vessels, both swine and calf experiments were performed. METHODS Seven pigs and three calves were included in this study. Five pigs underwent a total of 8 segmental and 5 main renal artery occlusions, while two pigs underwent main renal artery clamping. Three calves underwent a total of 5 main renal artery occlusions. All animals, except the first pig and calf, underwent partial nephrectomy. Four partial nephrectomies were performed in an open fashion and four were performed laparoscopically. Duration of selective ischemia was recorded and location of vascular occlusion was noted both angiographically and visually. All resection sites were closed over a hemostatic bolster. Polymer reversal from a solid back to a liquid state with iced saline allowing reperfusion was evaluated. Following surgery, all animals were euthanized. RESULTS Selective renal ischemia was achieved in all cases using Lumagel™. Hemostasis was achieved for 30 minutes in all main and segmental renal artery occlusions. Surgical resection time averaged 11 minutes (range 10–13) and 23.3 (range 9–40) in the open and laparoscopic groups, respectively. Estimated blood loss was negligible with the exception of one case where an insufficient dose of polymer was used. Minimal venous back bleeding was noted with isolated main renal artery occlusion. Reversal of the polymer to a liquid state was consistent angiographically and visually in all ten cases. Time to complete flow return averaged 7 and 2.5 minutes for Lumagel™ and arterial clamping, respectively. CONCLUSIONS We have developed a reliable and reproducible technique for the delivery and dissolution of Lumagel™ for temporary vascular occlusion in both main and segmental renal arteries, ranging from 2 to 8mm in diameter. Lumagel™ is as effective as vascular clamping in producing a bloodless operative field. Time to complete flow return to the kidney is greater with Lumagel™. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e487 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Niall Harty Burlington, MA More articles by this author Spencer Kozinn Burlington, MA More articles by this author Jessica DeLong Burlington, MA More articles by this author Ali Moinzadeh Burlington, MA More articles by this author Sebastian Flacke Burlington, MA More articles by this author James Benn Woburn, MA More articles by this author John Libertino Burlington, MA More articles by this author Peter Madras Burlington, MA More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...