Renal Artery Injury Research Articles

Single-incision Retroperitoneal Laparoscopic Resection of Adrenal Tumors in Children

BackgroundWe describe our experience with single-incision retroperitoneal laparoscopic (SIRL) for resection of adrenal tumors in pediatric patients and discuss the technique's clinical value. MethodsWe retrospectively analyzed clinical data of 27 pediatric patients who underwent SIRL between January 2020 and September 2023. Patients with tumors >5 cm in size and those requiring vascular skeletonization surgery or extensive lymph node dissection were excluded. Demographic, perioperative, and prognostic data were collected, and computed tomography (CT) and magnetic resonance imaging were used for preoperative tumor assessment. ResultsOf 27 patients, 16 were male and 11 were female; mean age 54 ± 45 months and mean body mass index 17.2 ± 3.6 kg/m2. Mean tumor length, width, and height were 4.1 ± 1.8 cm, 3.3 ± 2.1 cm, and 2.9 ± 1.7 cm, respectively. One patient experienced a diaphragmatic tear, three patients incurred peritoneal damage, and one patient developed postoperative renal artery injury, leading to thrombosis and renal atrophy. No surgery was converted to open surgery, and no intraoperative or postoperative blood transfusions were required. Operative time, blood loss, and postoperative dietary recovery time were satisfactory. No local recurrence or distant metastases were detected during the 6–48 months of follow-up involving outpatient and telephone assessments. ConclusionsApplication of SIRL in pediatric patients with adrenal tumors achieved favorable clinical outcomes with an effective, minimally invasive surgical option for treating children with adrenal tumors. This technique demands a high level of surgical expertise, specialized instruments and experienced surgeons. Our findings indicate that SIRL is safe and provides significant postoperative benefits in pediatric patients. Level of EvidenceLevel IV.

Traumatic Renal Artery Injuries: A Comprehensive Case Study Analysis

Post-traumatic renal artery injury is a rare yet critical complication following trauma, potentially leading to severe renal damage and functional loss. We present three cases of post-traumatic renal artery injury resulting in renal ischemia due to late diagnosis. Of particular note is that the interval between the first patient and the third is only three months, occurring at a time when such lesions are rarely observed. These cases, all involving young male individuals, highlight the challenges of prompt identification and timely intervention in such injuries. Delayed diagnosis hampered attempts at surgical revascularization in all cases, and our hospital lacked resources for percutaneous revascularization procedures. Despite efforts to manage these injuries conservatively, the success rates of surgical revascularization have been limited, leading to recurrent thrombosis. This has prompted the medical community to reconsider the approach to managing these injuries, with emphasis on non-operative methods and less invasive alternatives, particularly in the presence of a functioning contralateral kidney. However, determining the optimal management strategy remains elusive due to insufficient evidence regarding the efficacy of various approaches. Urgent management of renal artery injuries aims to preserve kidney function and mitigate secondary complications, such as renovascular hypertension. Long-term follow-up revealed varying outcomes among these patients, emphasizing the complex nature of managing post-traumatic renal artery injuries

Woven Endo Bridge shape modification contributes to decrease in adequate occlusion rate after Woven Endo Bridge implantation for wide-neck bifurcation intracranial aneurysms.

Recently, a novel device, the Woven Endo Bridge (WEB), was developed for wide-neck bifurcation intracranial aneurysms (WNBAs). The aim of this study is to investigate factors that contribute to adequate occlusion (AO) after the operation using detailed radiological images. The subjects were 29 patients with 29 aneurysms who received WEB implantation for WNBAs between December 2020 and April 2022. We assessed the contributing factors to AO by retrospectively comparing the AO group and non-AO group. The mean age was 64.6 ± 13.1years, and 18 were female (62.1%). The mean aneurysm dome width, aneurysm height, and aneurysm neck diameter were 4.8 ± 0.6mm, 5.1 ± 0.6mm, and 3.7 ± 0.6mm, respectively. After about 6months, 22 of 29 patients (75.9%) had AO. Complications were observed in 2 patients (6.9%), renal artery injury in one, and minor cerebral infarction in another, but the modified Rankin scale scores of both patients remained unchanged. Multivariate analysis extracted only WEB shape modification (WSM) as a contributing factor to AO (odds ratio: 0.912, p = 0.0287). WEB implantation for WNBAs was a treatment modality with acceptable efficacy and safety. WSM was the only significant factor contributing to non-AO after the treatment. We should clarify the mechanisms or causes of WSM to achieve AO after WEB implantation in future.

Role Of Renal Artery Embolization In Treatment Of Iatrogenic Renal Bleeding.

To review institutional experience about the effectiveness and safety of percutaneous trans-arterial renal artery embolization in the treatment of iatrogenic renal bleeding. The prospective study was conducted from December 2019 to December 2021 at Ain Shams University Hospital and Kafrelsheikh University Hospital, Egypt, and comprised patients of either gender who underwent renal artery embolization for iatrogenic arterial renal bleeding caused by percutaneous nephrolithotomy, renal biopsy and percutaneous nephrostomy. Diagnostic renal angiography was done to detect pseudoaneurysm and arteriovenous fistula. Embolization was done with either micro-coils or glue. Success of the procedure was defined astotal occlusion of the bleeding artery proved by post-embolization angiogram. Of the 15 patients, 9(60%) were males and 6(40%) were females. The overall mean age was 35+/-14 years. Percutaneous nephrolithotomy was the main cause 8(53.3%), followed by renal biopsy 5(33.3%) and percutaneous nephrostomy 2(13.2%). There were 9(50%) cases of pseudoaneurysm and 6(40%) of arteriovenousfistula. Embolization was done with micro-coils in 5(33.3%) cases and with glue in 10(66.6%). The technical success rate was 15(100%). No major complicationsrequiring intensive care orsurgical intervention were encountered, and there was no significant differences in estimated glomerular infiltration rate or renal function after renal artery embolization (p>0.05). Percutaneous endovascular renal artery embolization was found to be a safe and effective technique in the management of iatrogenic renal arterial injury.

Vascular injury during laparoscopic partial nephrectomy in a solitary kidney: management, outcome and audit

BackgroundVascular injury during laparoscopic partial nephrectomy is a dreadful complication. Though it is a commonly discussed complication, the literature on the circumstances leading to vascular injury, methods of managing the complication and reporting of final outcomes in those cases are limited. We report a case of vascular injury during laparoscopic partial nephrectomy for a hilar tumor in a solitary kidney. We highlight the management of the complication, present the outcome and review the surgical technique.Case presentationA 62-year-old male with solitary kidney presented with left renal hilar mass of size 4.4 × 3.8x3.6 cm. The renal nephrometry score was 10ph. The serum creatinine at the time of presentation to the hospital was 1.4 mg/dl. Laparoscopic partial nephrectomy was performed. The patient had severe intraoperative bleeding due to a segmental renal artery injury. The bleeding presented after hilar unclamping and was managed by intracorporeal vascular repair. The blood loss was around 500 ml. The postoperative period was uneventful without the need for hemodialysis. The histopathology report was suggestive of clear cell renal cell carcinoma with negative surgical margin. The follow-up magnetic resonance urogram did not show evidence of any arterial pseudoaneurysm or residual/recurrent tumor. At 18-month follow-up, the serum creatinine was 1.9 mg/dl and the patient did not have any complaints.ConclusionsComplication of vascular injury while performing laparoscopic partial nephrectomy for complex hilar tumors should be anticipated beforehand. Contingency plans to tackle this complication must be in place before attempting the surgery. Intracorporeal repair of vascular injury during laparoscopic partial nephrectomy is feasible when expertise is available. Low threshold for using endoscopic ultrasound, employing cold ischemia techniques, careful usage of hot cut during tumor resection and complete defatting of the kidney can all be considered ‘safe surgical practices’ during laparoscopic partial nephrectomy for complex hilar tumors. Following aforementioned ‘safe surgical practices’ helps in improving the outcomes and reducing the possibility of complication of vascular injury and helps in managing the complication effectively if it happens despite the precautions.

Iatrogenic Renal Artery Injury in 90 Cases: Arteriographic Findings and Outcomes after Embolization for Bleeding

PurposeTo evaluate differences in arteriographic findings and outcomes after embolization among patients with a suspected iatrogenic renal arterial injury (IRAI). Materials and MethodsPatients at the authors’ institution who underwent renal arteriography for suspected IRAIs after partial nephrectomy, biopsy, or percutaneous access over a 20-year period were included. Records, imaging, and outcomes were reviewed. Data analysis was performed using the Fisher exact or Kruskal-Wallis test. ResultsNinety arteriograms were performed on 83 patients after partial nephrectomy (n = 32), biopsy (n = 27), or percutaneous access (n = 24), including for nephrostomy/ureterostomy and stone removal. The median number of days between the index procedure and arteriogram was highest (15 days) after partial nephrectomy and lowest (5 days) after biopsy (P = .0001). Embolization was performed during 76% of arteriograms. If prearteriographic imaging showed positive results for IRAIs, embolization was performed in 67% versus 33% if imaging showed negative results (P = .005). The transfusion rate was higher after biopsy than after partial nephrectomy or percutaneous access (P = .002). Acute kidney injury after arteriogram occurred in 7% of patients; however, all returned to baseline by 1 week. ConclusionsDespite the different mechanism of IRAIs in partial nephrectomy, biopsy, and percutaneous access, arteriographic findings and outcomes were overall similar among groups. Prearteriographic imaging can help identify IRAIs but cannot supersede the clinical judgment regarding indication for embolization. IRAIs can present acutely or after a long interim, although patients who underwent biopsy presented earlier and more frequently required a blood transfusion. IRAIs can be treated with embolization without permanent deleterious effects on renal function.

Laser renal denervation: A comprehensive evaluation of microstructural renal artery lesions.

Renal artery denervation (RDN) has been proposed for resistant arterial hypertension. Beyond conventional radiofrequency (RF) ablation, there are emerging RDN technologies, including laser catheter ablation. We aimed at evaluamting the local effects of laser ablation on the renal artery and perivascular nerve injury in comparison with radiofrequency ablation. Thirteen pigs (mean weight 36.7 ± 4.7kg, age 3months) were divided into three groups: (1) laser ablation in normotensive pigs (LA; n=3), (2) bipolar RF ablation in normotensive pigs (RF; n=7), and (3) a sham group (SHAM; n=3). Transcatheter laser and RF ablations were performed under general anesthesia. After euthanasia, pathology and immunohistochemical studies were performed. Artery wall and perivascular nerve lesions were found in the LA and RF groups. A lower rate of intimal microdissections was evaluated after laser ablation when compared with RF ablation (0 vs. 1.5 [1;2.75] per artery; p < .05). There was a numerical prevalence of nerves with tyrosine hydroxylase expression loss after laser RDN when compared with RF ablation (16.7 [4; 18] vs. 9.1 [0;18] per specimen). Laser ablation is noninferior to RF ablation regarding perivascular nerve injury and is associated with less intimal layer damage.

Renal Infarction in Vascular Ehlers-Danlos Syndrome

Renal infarction is a condition caused by sudden disturbance of renal arterial blood flow, which occurs frequently in cardioembolic disease, renal artery injury (trauma, Marfan syndrome, rarely Ehlers-Danlos syndrome), and in association with a hypercoagulable state. Ehlers-Danlos syndrome is a rare hereditary connective tissue disease characterized by skin fragility, hyperelasticity, hypermobility of small joints, and easy bruising. Among the subtypes, vascular Ehlers-Danlos syndrome is a very rare genetic disease caused by a mutation in the &lt;i&gt;COL3A1&lt;/i&gt; gene. As blood vessels are fragile due dysfunctional collagen synthesis, complications of bleeding due to arterial dissection or rupture are common in patients with this disease. Here, we report a case of vascular Ehlers-Danlos syndrome diagnosed based on a renal infarction caused by thrombus and renal artery injury; we also present a review of the relevant literature.

Endovascular Treatment of post-traumatic Renal Artery Dissection.

Blunt renal artery injuries are rare, and no single trauma center has accumulated sufficient experience to draw meaningful conclusions or recommendations about optimal therapeutic strategies.[1]&#x0D; The increased use of CT scans to evaluate blunt abdominal trauma identifies more acute renal artery injuries that may have gone undetected.[2]&#x0D; Patients with renal injury have limited options such as open surgical repair or anticoagulation.[3] The use of endovascular stents to treat trauma is a good option treatment. [4] But not every case is successful.&#x0D; The purpose of this case report is to describe the importance of accurate diagnosis and successful repair in emergency traumatic conditions by means of interventional radiology in cases of intimal damage to the renal arteries.&#x0D; We will present a 38-year-old man who shows on the emergency room because of an accident with abdominal and thoracic trauma. The patient complained of pain in the right side of the abdomen…&#x0D; Through Angiography, an intimal dissection localized in the upper pole of the right kidney was confirmed. We inserted an expandable balloon stent using a transfemoral approach to successfully repair the dissection.&#x0D; Conclusion: Blunt renal artery injury is rare. Nonoperative management should be considered an acceptable therapeutic option. Management of blunt renal injuries includes timely evaluation to maximize the preservation of renal function. Recent management trends support the consideration of endoluminal intervention for traumatic renal artery dissections.

Abstract No. 346 Iatrogenic renal artery injury: arteriogram findings and outcomes after embolization

Renal arterial injury requiring arteriogram and embolization is a complication after partial nephrectomy (PN) and renal biopsy (RB). This study evaluates arteriographic findings and outcomes post-embolization in patients with suspected vascular injury after PN and RB.

Ultrasound-guided percutaneous embolization of post renal biopsy gonadal artery pseudoaneurysm

Hemorrhage is the most frequently encountered post renal biopsy complication; reported in 12% to 14% of patients. Although the vast majority of these are due to renal artery injury, involvement of gonadal arteries is also rarely seen. These may be managed by the endovascular route, which has several limitations in this subset of patients. We report a case of a 69-year-old male with rapidly progressive glomerulonephritis, who underwent renal biopsy and developed a testicular artery pseudoaneurysm (PA). Successful embolization of this PA was performed under ultrasound guidance using a direct percutaneous approach. This is the first such case reported in the literature.

Optimal Strategy for HIFU-Based Renal Sympathetic Denervation in Canines.

Background: The association between the treatment efficacy and safety of high-intensity focused ultrasound (HIFU)-based renal sympathetic denervation (RDN) and the acoustic energy dose applied has not been fully studied and may provide important understanding of the mechanism that led to failure of the WAVE IV trial. The objective of this study was to externally deliver different HIFU doses to canines for RDN treatment and to investigate the optimal energy dose for HIFU-based RDN.Methods: Thirty canines were divided into five RDN groups according to dose of acoustic energy applied, and a sham control group that consisted of four canines was used for comparisons. All animals in the RDN groups underwent the RDN procedure with different acoustic energy doses, while in the sham control group, renal arteries were harvested without being subjected to acoustic energy delivery and were imaged using color Doppler flow imaging (CDFI). Blood pressure (BP) was recorded, and blood samples were collected before the RDN procedure and at 28 days after the RDN procedure. Histological examinations and measurement of renal tissue norepinephrine concentration were performed in all retrieved samples.Results: Suppression of BP was significant in the 300 W (15.17/8.33 ± 1.47/1.21 mmHg), 250 W (14.67/9.33 ± 1.21/1.37 mmHg), and 200 W (13.17/9.17 ± 2.32/1.84 mmHg) groups. Semiquantitative histological assessment of periarterial nerves around the kidney revealed that target nerves in the 300 W (9.77 ± 0.63), 250 W (9.42 ± 0.67), and 200 W (9.58 ± 0.54) groups had the highest nerve injury scores, followed by the 150 W group (5.29 ± 0.62). Furthermore, decreased renal tissue norepinephrine concentration, together with decreased expression of tyrosine hydroxylase in the 300, 250, and 200 W groups demonstrated effective sympathetic depression following sufficient acoustic energy deposition. However, the renal artery injury score in the 300 W group (0.93 ± 0.13) was significantly higher than in the other groups (p < 0.001).Conclusion: This study provides evidence that RDN effectiveness is based on the energy dose delivered and that 200–250 W is effective and safe in normal-sized canines.

Post-traumatic renal artery thrombosis secondary to blunt abdominal trauma: a rare case report

Background: Blunt abdominal trauma is one of the leading causes of morbidity and mortality among populations worldwide. However, renal artery injury due to blunt abdominal trauma is a rare occurrence. In this case, a patient who suffered multiple trauma was found in the emergency department, including blunt abdominal trauma, after a motor vehicle accident.Case report: A 13-year-old boy with multiple trauma was referred to our emergency department, with the primary consideration being to lose consciousness 3 hours before admission due to a traffic accident. After receiving examination, there was no evidence of abdominal bruising, whereas the results of the head CT scan show epidural hemorrhage. After four days of treatment, the urea and creatinine serum levels increased, abdominal CT scan shows right renal infarction suggestive of right renal arterial rupture. The patient was diagnosed with a moderate head injury and right renal trauma AAST grade IV. The patient was referred to the interventional radiology unit. The endovascular revascularization techniques were performed with renal artery stent placement and vasodilator (nitroglycerin) flush into the renal artery before stent placement. Renal artery stenting placement performed on main right renal artery demonstrates the absence of intraluminal defects and substantially blood flow was established, abdomen CT Scan shows an enhancement on right renal parenchyma which mean right kidney vascularization appears to be improved with the return of glomerular filtration rate to normal value at the time the patient was discharged.Conclusion: Traumatic renal artery thrombosis is a rare occurrence with devastating consequences if any imaging is missed. Endovascular therapy plays a significant role in the treatment of renal artery thrombosis with a better prognosis.

Blunt renal trauma-induced hypertension in pediatric patients: a single-center experience

Children have a greater chance of sustaining a renal injury than adults and higher odds of having a high-grade renal injury. Hypertension is a rare complication of blunt renal trauma, with risk being higher in cases of major renal trauma. We reviewed the cases of pediatric blunt renal trauma-induced hypertension in our tertiary referral center in an attempt to better understand this rare condition. A retrospective evaluation of children under the age of 18 who were admitted to our department during the last 20 years and were diagnosed with blunt renal trauma. Twenty-three children presented with blunt renal trauma, one of whom was treated with emergency nephrectomy. Four children (18%) developed post-traumatic hypertension. All four cases were associated with a reduction in blood flow to the kidney, either through injury to the renal artery (in three cases) or through extrinsic compression of the kidney by a large perirenal hematoma (Page kidney; in one case). The Page kidney case developed hypertension during the initial hospitalization, and it resolved spontaneously after five months through the gradual resorption of the perirenal hematoma. Among the three cases of renal artery injury, hypertension during the initial hospitalization was only observed in one case, with hypertension in the other two cases manifesting after two months and four years, respectively. All three cases of renal artery injury resulted in a complete loss of function of the injured kidney, and two cases were treated with nephrectomy. Following nephrectomy, the blood pressure level returned to normal within a few days. Development of hypertension following a blunt renal trauma can be heterogenous, with the time of manifestation stretching between days after the accident and years thereafter. Children have a higher risk of renal trauma and, according to published data out of the National Trauma Data Bank, a 20-times higher risk of renal artery injury in comparison to the adult population. Large multicenter studies are required to answer the question of whether children are therefore more prone to blunt renal trauma-induced hypertension than adults. Our study highlights the importance of blood pressure monitoring in children following blunt renal trauma, as post-traumatic hypertension can develop even years after the accident. In cases of a poorly functioning kidney, nephrectomy may be regarded as a curative therapy.

A critical view of safety in left colectomy surgery: A case of renal artery injury.

IntroductionThe standardization of the laparoscopic approach in left hemicolectomy was facilitated by the vascular anatomy of the left colon, which has few anatomical variants. The current technique for left hemicolectomy consists in approaching the inferior mesenteric artery (IMA), after identification of the inferior mesenteric vein (IMV), from above (craniocaudal) or from below (caudocranial). The type of approach is decided on the basis of the vascular window between the IMV and IMA. However, vascular abnormalities of adjacent organs can call into question the steps of the standardized technique.Case presentationWe describe a case of iatrogenic left renal artery injury caused during left laparoscopic hemicolectomy due to an abnormality of the renal vessels. The artery originated from the aorta more caudally than usual with respect to the normal population.DiscussionWhat happened made us question the security of the standardized approach in practice, especially in patients with vascular anomalies. The use of advanced imaging programs, such as 3D reconstruction, can help to prevent iatrogenic damages, but not all hospitals have such technology, especially in rural areas.ConclusionWe propose, to further decrease the risk of iatrogenic injuries, a “critical view of safety” for left colic surgery, in which, before any potential arterial resection, a careful craniocaudal and caudocranial dissection of the Toldt-Gerota plane could be useful in identifying the IMA at the center of this plane. Moreover, a preoperative imaging study is of paramount importance in all surgical procedures.

Epidemiology and management of isolated blunt renal artery injuries.

Isolated blunt renal artery injury (BRAI) is uncommon. Treatment options include observation, nephrectomy, surgical reconstruction and endovascular stenting. Over the last decade, there has been an increasing use of angiointervention techniques in vascular trauma. Previous studies reported underutilization of endovascular stenting in BRAI, in favor of observation. The aim of this study was to examine the epidemiology and assess changes in the management of isolated BRAI over the last decade. Patients with BRAI identified from the National Trauma Data Bank (2016-2017). Deaths in the emergency department, transferral from outside hospital, and those with associated high-grade kidney injuries were excluded. Demographics, type of renal artery injury, and renal artery management were analyzed. Multivariate analysis was used to identify independent factors associated with isolated BRAI. During the study period, there were 1,708,076 patients with blunt trauma and 873 (0.05%) of them had BRAI. After exclusions, 563 patients with isolated BRAI who met the criteria for inclusion in the analysis. Auto versus pedestrian mechanism and male sex were associated with the highest risk for isolated BRAI. Comorbidities, such as hypertension or diabetes, were not associated with an increased risk of BRAI. Seatbelt use had a protective effect against BRAI. In the majority of patients (534, 95%), the renal artery injury was treated with observation, 23 (4%) with nephrectomy, 5 (0.9%) with endovascular stent and 1 (0.2%) with open renal artery repair. Among the 103 patients with isolated major renal artery laceration, 91.2% were treated with observation, 7.8% with nephrectomy and 1% with stenting. Isolated blunt renal artery trauma is rare. The vast majority of patients with BRAI is managed with observation with only a small number undergoing endovascular intervention. Endovascular stenting utilization has remained very low and has not changed in the last decade.

12-Month Results From the Unblinded Phase of the RADIANCE-HTN SOLO Trial of Ultrasound Renal Denervation.

This study reports the 12-month results of the RADIANCE-HTN (A Study of the ReCor Medical Paradise System in Clinical Hypertension) SOLO trial following unblinding of patients at 6months. The blood pressure (BP)-lowering efficacy and safety of endovascular ultrasound renal denervation (RDN) in the absence (2months) and presence (6months) of antihypertensive medications were previously reported. Patients with daytime ambulatory BP≥135/85mmHg after 4weeks off medication were randomized to RDN (n=74) or sham (n=72) and maintained off medication for 2months. A standardized medication escalation protocol was instituted between 2 and 5months (blinded phase). Between 6 and 12months (unblinded phase), patients received antihypertensive medications at physicians' discretion. Outcomes at 12months included medication burden, change in daytime ambulatory systolic BP (dASBP) and office or home systolic BP (SBP), visit-to-visit variability in SBP, and safety. Sixty-five of 74 RDN patients and 67 of 72 sham patients had 12-month dASBP measurements. The proportion of patients on≥2 medications (27.7% vs. 44.8%; p=0.041), the number of medications (0 vs. 1.4; p=0.015), and defined daily dose (1.4 vs. 2.2; p=0.007) were less with RDN versus sham. The decrease in dASBP from baseline in the RDN group (-16.5 ± 12.9mmHg) remained stable at 12months. The RDN versus sham adjusted difference at 12months was-2.3mmHg (95% confidence interval [CI]:-5.9 to 1.3mmHg; p=0.201) for dASBP,-6.3mmHg (95%CI:-11.1 to-1.5mmHg; p=0.010) for office SBP, and-3.4mmHg (95%CI:-6.9 to 0.1mmHg; p=0.062) for home SBP. Visit-to-visit variability in SBP was smaller in the RDN group. No renal artery injury was detected on computed tomographic or magnetic resonance angiography. Despite unblinding, the BP-lowering effect of RDN was maintained at 12months with fewer prescribed medications compared with sham.

Massive hemorrhage after percutaneous kidney biopsy caused by renal artery malformation: a case report and literature review

BackgroundAccessory renal artery (ARA) is the most common site for anatomical variation of renal supply artery. Rare studies reported interventional embolization for the management of massive hemorrhage caused by ARA injury after percutaneous kidney biopsy (PKB).Case presentationWe describe a 35-year-old man who developed massive hemorrhage after PKB leading to shock. Digital subtraction angiography (DSA) showed hemorrhage in the ARA at the inferior pole of the right kidney and hemostasis was noticed after renal artery embolization.ConclusionsWe proposed that much attention should be paid to the presence of ARA before PKB. In addition, digital subtraction angiography combined with superselective embolization is the best choice for the treatment of renal artery injury.

Experience With 15 Years of Laparoscopic Donor Nephrectomy: Review of 2500 Cases

BackgroundLaparoscopic donor nephrectomy (LDN) is considered the gold standard for live donor nephrectomies owing to lesser pain, shorter hospitalization, and earlier return to normal activities, yet it remains a technically challenging surgery. Repetition of a highly skilled task such as LDN should lead to improved performance reflected in shorter surgery times and a decrease in adverse events. MethodsThe records of over 2524 LDNs from February 2004 to June 2019 were evaluated for duration of surgery (from incision time to clamping of the renal artery) and occurrence of complications. ResultsThe mean duration of surgery ± SD from incision to clamp time for the first 100 cases at the inception of LDN was 166.13 ± 33.28 minutes whereas it was 124.59 ± 35.91 minutes for the best 100 consecutive cases in 2015 with a decrease of 41 minutes duration of surgery from incision to artery clamping. The adverse events were accessory renal artery injury (n = 10), splenic laceration (n = 2), bowel and mesocolon injuries (n = 12), venous or arterial clip slippage (n = 4), inferior vena cava tear (n = 2) pneumothorax (during stapler application, n = 1), missing gauze counts (n = 1), chylous ascites (n = 1), ureteric thermal injury (n = 2), and renal parenchyma injury (n = 3). ConclusionsLDN is a technically demanding surgery where surgeon experience appears to affect operative metrics such as operative time. The occurrence of intraoperative complications appears to be acceptably low, although serious complications are a possibility.

MP66-19 INVESTIGATION OF UROLOGY INTRAOPERATIVE EVENTS LEADING TO ROOT CAUSE ANALYSIS AT NATIONAL VETERANS AFFAIRS MEDICAL CENTERS

You have accessJournal of UrologyGeneral & Epidemiological Trends & Socioeconomics: Quality Improvement & Patient Safety III (MP66)1 Apr 2020MP66-19 INVESTIGATION OF UROLOGY INTRAOPERATIVE EVENTS LEADING TO ROOT CAUSE ANALYSIS AT NATIONAL VETERANS AFFAIRS MEDICAL CENTERS Leslie M. Peard*, William Gunnar, Peter Mills, and Andrew M. Harris Leslie M. Peard*Leslie M. Peard* More articles by this author , William GunnarWilliam Gunnar More articles by this author , Peter MillsPeter Mills More articles by this author , and Andrew M. HarrisAndrew M. Harris More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000941.019AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Root Cause Analysis (RCA) is a well-known and effective method of analyzing errors made in the healthcare setting. We aimed to categorize events leading to RCA in urology ORs at VA medical centers in order to increase understanding of when RCA may be appropriate and if where changes may be implemented as a result. METHODS: A dataset of surgery RCAs at VA medical centers that were submitted between the start of fiscal year 2015 to present was created using terms including urology, -gic, -gist, vasectomy; prostatectomy (including TURP, RRP, LRP, PVP), nephrectomy, cystectomy, cystoscopy, lithotripsy, kidney stone, ureteroscopy, ureter, -al, urethral, TURBT, bladder/prostate cancer, and gleason. Cases that did not pertain to an event in a urology OR were excluded. The cases were then categorized based on the type of event. RESULTS: A total of 62 cases were identified. The most common pattern identified was equipment or instrument issue with 23 cases. For example, ‘no sterile flexible ureteroscopes available for scheduled ureteroscopy identified after patient asleep’; ‘smoking light cord’. There were 12 events categorized as retained foreign bodies (surgical sponge, retained guidewire), 8 pertaining to medical or anesthesia event (incorrect dosing, STEMI during TURP), and 7 pertaining to pathology errors (missing specimen, incorrect diagnosis later revised, mislabeled specimen). There were 6 wrong site surgeries (wrong side ureteral stent placement, prostate biopsy performed in patient scheduled for cystoscopy), 5 cases with incorrect patient information or consent (TURBT performed without consent), and 4 cases identified as major surgical complications (renal artery injury during ureteroscopy, unrecognized bladder perforation during TURP). In 2 cases the wrong case was performed or there was inappropriate work up. One case caused a significant delay in treatment, one case pertained to an incorrect count, and one case identified lack of appropriate credentialing. CONCLUSIONS: RCA is an important tool in improving quality and safety of care. We identified several patterns of events leading to RCA pertaining to urologic operating rooms. By categorizing theses variables, we can better identify targets for efforts on improving quality and safety in our operating rooms. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e991-e992 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Leslie M. Peard* More articles by this author William Gunnar More articles by this author Peter Mills More articles by this author Andrew M. Harris More articles by this author Expand All Advertisement PDF downloadLoading ...