The Use of Three Different Hemostatic Agents during Laparoscopic Partial Nephrectomy: A Comparison of Surgical and Early Renal Functional Outcomes.

Serdar Aykan,Mehmet Yilmaz,Serkan Gonultas,Ismail Ulus,Serhat Suzan,Ahmet Yaser Muslumanoglu,Atilla Semercioz,Mustafa Zafer Temiz

doi:10.5152/eurasianjmed.2018.18293

Abstract

This study aimed to compare the effects of three different hemostatic agents on surgical and early renal functional outcomes after laparoscopic partial nephrectomy (LPN). A total of 126 cases of LPN performed between November 2008 and September 2016 were enrolled in this study. Spongostan™ Absorbable Hemostatic Gelatin Sponge (Ethicon, Somerville, NJ, USA) or Surgicel® Original Absorbable Hemostat (Ethicon, Somerville, NJ, USA), or a total of 5 mL of Floseal® Hemostatic Matrix (Baxter Healthcare, Deerfield, IL) was used for additional hemostasis. According to the hemostatic agent used, patients were divided into three groups; and patient characteristics, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor characteristics, perioperative parameters, serum creatinine levels, and complications were compared among these three groups. Age, BMI, ASA score, tumor characteristics, operative time, warm ischemia time, complication rates, and length of hospital stay were similar among the groups, whereas estimated blood loss was significantly lower in the Floseal Group (p=0.01). Postoperative serum creatinine levels and differences between preoperative and postoperative serum creatinine levels were also similar among the groups. The type of hemostatic agent used in LPN may affect the estimated blood loss. However, it has no substantial effect on other surgical parameters and early renal functional outcomes.

Highlights

Because of the advancement and extensive application of imaging techniques, kidney cancer has become an early-diagnosed clinical entity in the recent years
A total of 126 cases of laparoscopic partial nephrectomy (PN) (LPN) for renal tumors performed with the use of three different types of hemostatic agents between November 2008 and December 2016 were enrolled in this retrospective study
All data including patient characteristics, body mass index (BMI), American Society of Anesthesiologists (ASA) score, tumor characteristics, perioperative parameters and details, preoperative and postoperative serum creatinine levels, and perioperative and postoperative complications were obtained from the computer-based patient record system and our institutional nephrectomy case assessment forms

Summary

Introduction

Because of the advancement and extensive application of imaging techniques, kidney cancer has become an early-diagnosed clinical entity in the recent years. Open PN is considered as the gold standard surgical treatment for T1 renal tumors, laparoscopic technique has been the most preferred approach because of advancement of laparoscopic surgery in recent years. The procedure has technical difficulties such as successful tumor excision, renal parenchymal wound closure, and reconstruction of the collecting system with allowable warm ischemia time [6, 7]. These technically demanding aspects may cause some complications such as hemorrhage, urine leakage, and renal functional deterioration [7, 8]

Methods

Results

Conclusion