V08-12 BLEEDING DISASTER MANAGEMENT DURING ROBOTIC RENAL SURGERY

Abstract

You have accessJournal of UrologyProstate & Renal Oncology II1 Apr 2018V08-12 BLEEDING DISASTER MANAGEMENT DURING ROBOTIC RENAL SURGERY Amit Patel and Craig Rogers Amit PatelAmit Patel More articles by this author and Craig RogersCraig Rogers More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1978AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Intraoperative complications are reported in approximately 1.8% of robotic partial nephrectomy (RPN) cases. We demonstrate examples of published algorithms for management of bleeding during robotic kidney surgery using real-life scenarios in video format. METHODS We present 8 robotic renal surgery cases (5 partial, 3 radical nephrectomy) demonstrating management of escalating vascular injuries, bleeding during renorraphy and excision of mass during RPN, management of a misfired endovasular stapler and bleeding during radical nephrectomy (missed upper pole vessel and torn parasitic vessel), one requiring open conversion. RESULTS Steps to manage vascular injuries included compression, cautery, increased pneumoperitoneum and utilization of a pre-prepared rescue suture. Techniques to avoid bleeding during excision and renorraphy included early unclamping to help visualize vessels, utilization of clips/sutures to visible vessels, additional tightening of renorraphy sutures and clamping maneuvers to avoid venous congestion while improving renal artery occlusion. Steps to manage bleeding during nephrectomy included removal of remaining attachments to control a missed vessel and a controlled conversion to open procedure. 7 cases were managed with EBL<400ml, no transfusions, and hospital stay<3 days. One patient converted to open had an EBL of 800ml with 2 units transfused and a 5 day hospital stay. CONCLUSIONS Intraoperative bleeding during robotic renal surgery, although rare, can be disasterous if not managed appropriately. Familiarity of algorithms to manage intraoperative bleeding, and preparation for these scenarios, may help prevent unnecessary patient morbity. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e823 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Amit Patel More articles by this author Craig Rogers More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...