V1878 THE V-SHAPE HILAR STITCH (VHS) CLOSURE: A NOVEL ROBOTIC RENORRAPHY TECHNIQUE

Abstract

You have accessJournal of UrologyBladder Oncology & Reconstruction1 Apr 2011V1878 THE V-SHAPE HILAR STITCH (VHS) CLOSURE: A NOVEL ROBOTIC RENORRAPHY TECHNIQUE Shahab P. Hillyer, Gregory Spana, Michael A. White, Riccardo Autorino, Bo Yang, Humberto Laydner, Fatih Altunrende, Georges P. Haber, Robert J. Stein, and Jihad Kaouk Shahab P. HillyerShahab P. Hillyer Cleveland, OH More articles by this author , Gregory SpanaGregory Spana Cleveland, OH More articles by this author , Michael A. WhiteMichael A. White Cleveland, OH More articles by this author , Riccardo AutorinoRiccardo Autorino Cleveland, OH More articles by this author , Bo YangBo Yang Cleveland, OH More articles by this author , Humberto LaydnerHumberto Laydner Cleveland, OH More articles by this author , Fatih AltunrendeFatih Altunrende Cleveland, OH More articles by this author , Georges P. HaberGeorges P. Haber Cleveland, OH More articles by this author , Robert J. SteinRobert J. Stein Cleveland, OH More articles by this author , and Jihad KaoukJihad Kaouk Cleveland, OH More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2011.02.1981AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Renal parenchymal reconstruction during robotic partial nephrcetomy (RPN) can be challenging. The “Sliding-clip” technique has been introduced ad popularized to overcome this surgical step. A modification to the “Sliding-clip” technique, defined as “VHS” (V-shape, H-hilar, S-stitch) technique, is herein described to facilitate and improve renal reconstruction after excision of complex hilar tumors during RPN. METHODS RPN in a patient with solitary kidney presenting with a complex (6.1 cm) hilar tumor is performed using the VHS technique. After tumor excision, a first set of inner 2-0 running Vicryl sutures (SH-1) is placed at tumor bed on each side of the renal hilum. Suture placement is performed to model the remaining renal parenchyma in order to obtain a “V-shape” figure, the edges of renal defect being each “arm” of the “V”. This facilitates the following step, the horizontal mattress renorrhaphy, which is undertaken using 0 Vicryl on a CT-1 needle. Branching vessels are clipped using hem-o-lock clips as they are encountered during tumor excision. RESULTS Warm ischemia time and operative time were 29 and 158 minutes, respectively. Post-operative eGFR was 55 ml/min/m2 with a 16% decrease in eGFR and EBL was 350ml. A total of two inner sutures and four parenchymal sutures were used. Four were used during warm ischemia and 2 after bulldog clamps removed. The technique allowed complete closure of the renal defect when limited tissue was present for renorraphy. CONCLUSIONS VHS allows for easier approximation of the renal defect when limited tissue is available for reconstruction in complex hilar tumors. © 2011 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 185Issue 4SApril 2011Page: e753 Advertisement Copyright & Permissions© 2011 by American Urological Association Education and Research, Inc.MetricsAuthor Information Shahab P. Hillyer Cleveland, OH More articles by this author Gregory Spana Cleveland, OH More articles by this author Michael A. White Cleveland, OH More articles by this author Riccardo Autorino Cleveland, OH More articles by this author Bo Yang Cleveland, OH More articles by this author Humberto Laydner Cleveland, OH More articles by this author Fatih Altunrende Cleveland, OH More articles by this author Georges P. Haber Cleveland, OH More articles by this author Robert J. Stein Cleveland, OH More articles by this author Jihad Kaouk Cleveland, OH More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...