Hemostatic Adjuncts in Laparoscopic Partial Nephrectomy

Abstract

Introduction: Laparoscopic partial nephrectomy has become an accepted standard of care in treating amenable small renal masses. With increasing experience and improved surgical hemostatic adjuncts, the procedure is being offered by many centers as a nephron-sparing surgical option. We present the different hemostatic adjuncts used in decreasing the risk of perioperative and postoperative bleeding associated with this surgical procedure. Materials and Methods: In our single-center experience, three surgeons performed 54 cases of transperitoneal laparoscopic partial nephrectomy. The patients and tumor radiological characteristics were assessed preoperatively and deemed feasible for nephron-sparing surgery. The renal hilum was clamped en-bloc using a laparoscopic vascular clamp. The tumor resection bed was thermally ablated using electrocautery in a spray mode. Renorraphy after renal tumor excision was performed in two layers. The inner layer was sutured using a barbed absorbable suture (V-Loc 90), while the outer layer was sutured, over an absorbable hemostat bolster (surgical), using 2.0 polyglactin suture and Lapra-ty absorbable clips. A hemostatic sealent (Floseal) was applied at the end of the procedure. All patients received intravenous mannitol around 15 minutes before hilar clamping. Results and Conclusions: Fifty-four patients (age range 42–71 years) underwent laparoscopic partial nephrectomy from January 2009 until May 2012. The mean tumor size was 2.7 cm, and the mean total warm ischemia time was 18.3 minutes. The mean operative blood loss was 224 mL. None of the patients in this series required a blood transfusion during or after the surgery. One patient was found to have a 2.1-cm renal pseudoaneurysm on follow-up imaging 3 months postoperatively. This was treated using selective embolization. Laparoscopic partial nephrectomy has become a standard of care in the management of small renal masses. The availability and proper use of hemostatic adjuncts help in minimizing the risk of bleeding and pseudoaneurysms. The authors have nothing to disclose. Runtime of video: 6 mins 34 secs