Satinsky Clamp Research Articles

Pulmonary artery resection with autologous pericardial conduit to avoid pneumonectomy in lung neoplasms surgery: How to do it

Pulmonary artery resection with autologous pericardial conduit to avoid pneumonectomy in lung neoplasms surgery: How to do it

Minimally-Invasive Radical Nephrectomy and Left-Sided Level II Caval Thrombectomy: A New Combined Technique

To present a combined multiport robotic and open approach for left radical nephrectomy and inferior vena cava thrombectomy in patients with a primary left renal mass and level II inferior vena cava (IVC) tumor thrombus. A 69-year-old female was diagnosed with an 8.9cm left renal neoplasm with level II IVC thrombus. She was placed in the left-side-up flank position. The descending colon was mobilized and the left gonadal vein was identified. The left renal vein was identified and fully dissected. The left renal artery was dissected and stapled. The kidney was dissected and left detached with exception of the renal vein. The robot was undocked and the patient was positioned supine. Through a supra-umbilical midline incision, the ascending colon and duodenum were mobilized medially. The right renal vein and IVC were identified and dissected to the level of hepatic veins. The IVC was clamped using a Satinsky clamp. The right renal artery and vein remained patent during thrombectomy. The IVC was opened, the thrombus was evacuated, and IVC was closed. Clamps were removed and the kidney was removed. Operative time was 405 minutes. IVC clamp time was 14 minutes. Estimated blood loss was 500cc. Recovery was uncomplicated. Length of stay was 4 days. Pathology showed clear cell carcinoma with negative margins. IVC thrombectomy is challenging on left sided tumors. Combining a robotic and open technique together is feasible and allows a smaller supra-umbilical midline incision compared to standard open incision.

In Loving Memory

<h3>Introduction/Background</h3> Adamantinoma is a rare primary low-grade malignant tum­­­­­­our of the appendicular skeleton. It primarily affects the long bones and is most commonly found in the tibia. The disease process has an indolent course and histogenic origin has not been clearly defined, however there have been several suggestions pertaining to a vascular origin in the literature. Local recurrences and lung metastases occur over a protracted duration. Less frequently, they have also been reported elsewhere; including four documented cases of soft tissue and five of pelvic bony adamantinoma. There is only one documented case of adamantinoma of the ovary and one of concurrent unrelated primary tumour. There are also no reports available regarding surgical management of a retroperitoneal adamantinoma of the pelvis within a gynaecological oncology surgical setting. Clinical guidelines have not yet been established. <h3>Results</h3> We present the case of a 65-year-old female with known recurrent and metastatic right tibial disease. On further investigation, a Positron Emission Tomography scan identified a primary breast lesion and an 11 cm mass in the right iliac fossa of suspected ovarian malignancy amenable to surgical resection (figure A). The patient underwent total abdominal hysterectomy, bilateral salpingo-oophorectomy and resection of a retroperitoneal mass arising from the pelvic sidewall encompassing the iliac vasculature. The tumour was cleaved from the external iliac artery successfully, however the external iliac vein perforated during dissection. A Satinsky clamp was placed and a small cuff of vein wall was removed alongside adherent tumour. The vein defect was closed with 5–0 prolene, ensuring a patent lumen (figure B). The patient made an uneventful recovery with histology confirming metastatic disease. <h3>Conclusion</h3> We present an overview of adamantinoma and highlight a previously undocumented gynaecological oncology surgical approach to this novel location of metastatic disease mimicking possible ovarian malignancy. We further explore disease histogenesis and also comment on an incidental finding or primary breast cancer. Particularly in uncommon locations, its heterogeneous nature presents radiological and histological challenges regarding diagnosis and treatment. Such cases warrant a full complement of MDT specialist knowledge and expertise; with advanced surgical skills and experience regarding retroperitoneal and pelvic sidewall anatomy. We also highlight a paucity of recommendations for surveillance and follow up and propose an individualised approach. We report on this unusual case to assist clinicians in the building of a consensus opinion for optimal adamantinoma case management under current circumstances where formal guidelines do not exist. <h3>Disclosures</h3> None

Robot-Assisted Laparoscopic IVC Treatment Strategy in Retroperitoneal Tumors.

ObjectivesTo show the practice of robot-assisted laparoscopic inferior vena cava (IVC) treatment strategies in patients with retroperitoneal tumors.Patients and MethodsFrom October 2020 to July 2021, 17 patients with retroperitoneal tumors successfully underwent robot-assisted laparoscopic tumor resection with IVC management. The patient details, tumor characteristics, intraoperative data, pathological features and severe complications were assessed. The IVC treatment strategies were divided into 4 ways: ①local resection and primary repair of the IVC; ②IVC ligation; ③ IVC reconstruction by bovine pericardial grafts; and ④ IVC transection and anastomosis.ResultsIn terms of IVC management, 5 cases had conventional total occlusion of the IVC and its branches, 3 cases had delayed occlusion of the proximal IVC technique, 2 cases had IVC resection by Satinsky clamp, 5 cases had IVC ligation, 1 case had IVC reconstruction by bovine pericardial grafts and 1 case had IVC transection and anastomosis. The median operation time was 151 min, and blood loss was 500 ml. There was no severe complication perioperatively. The follow-up time of 17 patients was 8 to 17 months (median: 12 months). No local recurrence or overall death was found during follow-up.ConclusionsThese robot-assisted laparoscopic IVC treatment strategies were considered to be safe and feasible in experienced centers, as well as helpful to completely remove the tumor for better oncological prognosis and restore the blood reflux of IVC as much as possible to ensure fewer postoperative complications.

Clinical experience with the treatment of retroperitoneal vascular leiomyosarcoma originating from large veins

BackgroundRetroperitoneal vascular leiomyosarcoma (RVLMS) is an extremely rare disease in clinical practice, and it has poor prognosis. This article is to explore the diagnosis and treatment of RVLMS and present our experience.MethodsData of RVLMS patients were continuously collected in our hospital from August 2018 to February 2020: two males and two females with a median age of 56 (min–max = 33–61) years were included. Patients in whom paraganglioma could not be excluded were asked to take phenoxybenzamine before surgery. A multi-disciplinary team (MDT) meeting had been held and surgery was recommended. The operation procedures varied based on the tumor location, shape, and stage, and the core steps were "exposure of the retroperitoneum and tumor, identification of vital blood vessels, blocking the bloodstream, complete removal of the tumor and tumor thrombus, and release of blood flow". A Satinsky clamp was used to partially block the blood vessels. Follow-up was conveyed by revisits and phone calls.ResultsOne patient underwent open surgery, and three patients underwent laparoscopic surgery, one of whom underwent conversion to open surgery. The procedures were finished successfully, with a median operative time of 314.5 (min–max = 224–467) mins. The median amount of intraoperative bleeding was 550 (min–max = 200–1500) ml, and three patients had transfusion during the operation. The mass was irregular in shape, with a median maximum size of 7.45 (min–max = 4.2–10.7) cm, and the pathological examination confirmed RVLMS, which has spindle-shape, high mitotic activity and atypia. One week after the operation, the median serum creatinine level was 85 (min–max = 70–99) µmol/L. The median follow-up time was 16 (min–max = 13–21) months, and 1 case reported asymptomatic recurrence.ConclusionUncharacteristic manifestations and imaging features contribute to the problematic diagnosis of RVLMS. Comprehensive preoperative evaluation and careful surgical planning are essential. Multicenter research is needed in the future to reach a dominant consensus.

Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience)

Background:Nephron sparing surgery is a well-established surgical procedure for patients with small/bilateral renal masses. During the procedure, hilar control can be achieved by using bulldog clamps individually on the renal vessels, the renal artery alone without clamping the vein, or a laparoscopic Satinsky clamp for en bloc hilar clamping. In our series, we described the outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control.Materials and methods:All eligible cases with confirmed diagnosis of a renal mass were advised of nephron sparing surgery. The short-term outcomes were evaluated by warm ischemia time (using a Satinsky clamp especially when CT renal angiography was not available), average blood loss, and length of postoperative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen, local recurrence, and distant metastasis.Results:Of 30 cases 20 were male. The mean age was 54.25 years. On preoperative evaluation, 24 cases were T1a stage and the rest were 6 T1b stage. Four tumors were located in the upper pole, 4 in the posterior midpole, and 22 in the lower pole. Twenty-six patients had a low complexity score on RENAL scoring (ie, 4–6) and 4 patients a medium complexity score (ie, 7–9). Three patients were converted to open partial nephrectomy because of technical difficulty in intracorporeal suturing and difficulty in achieving hemostasis. Among these 3 patients, 2 patients had posterior base tumors and 1 had a lower polar tumor. Average blood loss was 350 ml, warm ischemia time was 28.46 minutes, and postoperative stay was 4.55 days. Of 30 specimens for histopathology, 23 (76%) were clear cell renal cell carcinoma (RCC), 4 (13%) were papillary RCC, 1 (3.3%) was chromophobe RCC, whereas 2 (6.6%) were benign (oncocytoma). Margins were free of tumors in all the patients with no recurrence in 2 years of follow-up.Conclusion:Laparoscopic partial nephrectomy by using a Satinsky clamp as a tool for en bloc hilar clamping in the proper axis at the hilum takes care of multiple vessels irrespective of size and number, particularly when renal angiography is not available. This technique of en bloc hilar clamping is quite useful especially in developing countries where robotic facilities are not available. The Satinsky clamp decreases blood loss and intraoperative time.

Modified Suturing Techniques in Carotid Endarterectomy for Reducing the Cerebral Ischemic Time.

ObjectiveCarotid endarterectomy (CEA) is an effective surgical procedure for treating symptomatic or asymptomatic patients with carotid stenosis. Many neurosurgeons use a shunt to reduce perioperative ischemic complications. However, the use of shunting is still controversial, and the shunt procedure can cause several complications. In our institution, we used two types of modified arteriotomy suture techniques instead of using a shunt. MethodsIn technique 1, to prevent ischemic complications, we sutured a third of the arteriotomy site from both ends after removing the plaque. Afterward, the unsutured middle third was isolated from the arterial lumen by placing a curved Satinsky clamp. And then, we opened all the clamped carotid arteries before finishing the suture. In technique 2, we sutured the arteriotomy site at the common carotid artery (CCA). We then placed a curved Satinsky clamp crossing from the sutured site to the carotid bifurcation, isolating the unsutured site at the internal carotid artery (ICA). After placing the Satinsky clamp, the CCA and external carotid artery (ECA) were opened to allow blood flow from CCA to ECA. By opening the ECA, ECA collateral flow via ECA-ICA anastomoses could help to reduce cerebral ischemia. ResultsThe modified suture methods can reduce the cerebral ischemia directly (technique 1) or via using collaterals (technique 2). The modified arteriotomy suture techniques are simple, safe, and applicable to almost all cases of CEA. ConclusionTwo modified arteriotomy suture techniques could reduce perioperative ischemic complications by reducing the cerebral ischemic time.

A modified surgical technique of shortening renal ischemia time in left renal cancer patients with Mayo level II-IV tumor thrombus

BackgroundTo explore the safety and effectiveness of a modified surgical technique which could shorten the time of renal ischemia in left renal cancer and Mayo level II to IV inferior vena cava (IVC) tumor thrombus.MethodWe retrospectively analyzed the clinical data of 14 cases with left renal cell carcinoma (RCC) and Mayo level II to IV IVC tumor thrombus from February 2015 to July 2019. Preoperative imaging showed that there was no obvious sign of tumor thrombus invading the blood vessel wall. During the surgery, after the right renal artery, the right renal vein and the distal end of IVC were blocked, the balloon catheter was used and the tumor thrombus was removed completely from the IVC. The incision of IVC was closed by Satinsky clamp to make IVC partially blocked. Then the right renal artery and right renal vein were released. The incision of IVC was sutured continuously. At last, the Satinsky clamp and the blocking band at the distal end of the IVC were released.ResultThere were 8 cases (57.1%) of Mayo level II, 3 cases (21.4%) of Mayo level III and 3 cases (21.4%) of Mayo level IV. The operation was successfully completed in all 14 patients. There were 2 cases (14.3%) operated by complete laparoscopic approach, 8 cases (57.1%) by open approach, and 4 patients (28.6%) by laparoscopic conversion to open approach. The occlusion time of right renal artery and vein (renal ischemia time) was 3 to 15 min, with an average of (6.8 ± 3.2) minutes. The mean time of IVC occlusion was (19.4 ± 4.9) min. Preoperative creatinine was 66 to 130 μmol/L, with an average of (96.6 ± 21.2) μmol/L. One week after operation, serum creatinine was 64 to 632 μmol/L, with an average of (132.4 ± 144.9) μmol/L. Among the 14 cases, 5 (42.9%) had early postoperative complications. Besides one of the 14 patients died in perioperative period, the median follow-up of other 13 cases was 10 months (range: 4–29 months). The 5 (35.7%) of the 14 cases were died of disease.ConclusionThis modified procedure was relatively safe and effective in shortening the time of renal ischemia in left RCC patients with Mayo II to IV IVC tumor thrombus.

Surgical management of complicated sporadic pulmonary arterio venous malformation

The onset of a spontaneous hemothorax may represent a life threatening emergency. Several etiologies may be involved, mainly vascular abnormalities. Pulmonary Arteriovenous Malformation (PAVM) is a rare etiology, and it is often associated with Hereditary Hemorrhagic Telangiectasia (HHT). We report the case of a young women who was presented to the emergency department with left basal chest pain and mild dyspnea. Hemodynamic and respiratory states were maintained. Vesicular murmuring was abolished on the left side. The chest roentgenogram showed a left pleural effusion with mild deviation of the mediastinum to the opposite side. Thoracocentesis found a serohematic liquid. While the patient was undergoing exploration by computed chest tomography, she represented a cardio respiratory arrest. Resuscitation was successful after few minutes. The chest CT showed a PAVM located on the upper lobe that was very enhanced after injection of the contrast product, with a feeding artery coming from the pulmonary artery. The patient underwent an emergent left upper lobectomy thorough a posterolateral thoracotomy. The PAVM was peripheral, large with a diameter of 5 cm, and ruptured on the pleural cavity. Elective controlling the hemorrhage was very difficult, so a total hilar clamping was done with a Satinsky clamp. The postoperative course was complicated with pulmonary embolism managed by anticoagulation treatment. The definitive histological management concluded to a PAVM. Retrospectively, there was no personal or familial sign of HHT, neither any anomaly of blood hemostasis. Isolated PAVM is a rare cause of spontaneous hemothorax. Rapid worsening of an initially maintained state makes the situation more critical. Rapid control of a massive bleeding is mandatory to better explore and plan surgical resection. For stable patient, endovascular treatment may represent an effective option.

Resection of a metastatic bulky subphrenic tumor for the treatment of advanced ovarian cancer using liver mobilization and the Pringle maneuver

ObjectiveAdvanced ovarian cancer commonly disseminates to the diaphragm. A complete removal of a bulky diaphragmatic disease is sometimes difficult. We present the surgical technique that we used for resecting a large nodular and disseminated subphrenic tumor that occupied the subphrenic space using liver mobilization and the Pringle maneuver. MethodsThe patient was a 78-year-old woman with FIGO IIIC left ovarian carcinosarcoma. She had a metastatic subphrenic tumor measuring 12 cm in diameter. The subphrenic tumor resection was performed as a part of cytoreductive surgery. Owing to the adherence between the right diaphragm and the liver, the diaphragm was resected in full thickness. The liver was mobilized by keeping the resected part of the diaphragm attached to the liver. The subphrenic tumor and the attached diaphragm were resected en bloc by excising the liver which was adjacent to the tumor. During the resection, the hepatoduodenal ligament was clamped with a Satinsky clamp (Pringle maneuver) to reduce blood loss from the liver. The diaphragmatic defect was closed with permanent mesh. ResultsWe achieved complete cytoreduction with no residual tumor without ICU admission. No severe intraoperative or postoperative complications were observed. The patient was discharged on postoperative day 22 and started adjuvant chemotherapy on postoperative day 27. The histological examination revealed the carcinosarcoma in the diaphragmatic peritoneum, although the carcinosarcoma did not infiltrate the adjacent liver. ConclusionResection of a metastatic bulky subphrenic tumor using liver mobilization and the Pringle maneuver is a feasible technique for the treatment of advanced ovarian cancer.

Open Management of the Renal Vein Is a Safe Modification in Right-Sided Laparoscopic Living Donor Nephrectomy to Maximize Graft Vein Length

BackgroundThe primary objective in living donor kidney transplantation is donor safety. In laparoscopic living donor nephrectomy, most centers prefer the left kidney for donation given the shorter renal vein, higher rate of thromboses, and more difficult surgical procedure for right kidney retrieval. The goal of this study was to demonstrate the feasibility of a hybrid technique using a Satinsky clamp in right-sided living donor nephrectomy to obtain maximal renal vein and to compare the outcome with standard left-sided laparoscopic donor nephrectomies. Material and MethodsBetween 2005 and 2013, 77 patients underwent a left (group L) and 54 a right (group R) living donor nephrectomy. In group R, after laparoscopic dissection and mobilization of the right kidney, two 12-mm trocar incisions in the right upper quadrant were connected in a 5–7 cm subcostal incision. The caval vein was partially clamped under direct vision prior to dissection of the renal vein. The venotomy was then closed with a running 4-0 Prolene suture. The two groups were compared with regard to surgical complications, graft function, and graft survival. ResultsUsing this technique, no significant difference with regard to complications or graft function was observed. Serum creatinine at discharge in donor group L was 1.23 (±0.43) mg/dL and in donor group R 1.21 (±0.37) mg/dL (P = .71). Graft survival at one year was 100% in both groups. ConclusionOpen management of the renal vein is a safe alternative in laparoscopic right-sided donor nephrectomy and ensures maximal length of the vein.

Case reports of atrial and pericardial rupture from blunt cardiac trauma

BackgroundBlunt cardiac trauma is diagnosed in less than 10% of trauma patients and covers the range of severity from clinically insignificant myocardial contusions to lethal multi-chamber cardiac rupture. The most common mechanisms of injury include: motor vehicle collisions (MVC), pedestrians struck by motor vehicles and falls from significant heights. A severe complication from blunt cardiac trauma is cardiac chamber rupture with pericardial tear. It is an exceedingly rare diagnosis. A retrospective review identified only 0.002% of all trauma patients presented with this condition. Most patients with atrial rupture do not survive transport to the hospital and upon arrival diagnosis remains difficult.Case presentationWe present two cases of atrial and pericardial rupture. The first case is a 33-year-old female involved in a MVC, who presented unresponsive, hypotensive and tachycardic. A left sided hemothorax was diagnosed and a chest tube placed with 1200 mL of bloody output. The patient was taken to the OR emergently. Intraoperatively, a laceration in the right pericardium and a 3 cm defect in the anterior, right atrium were identified. Despite measures to control hemorrhage and resuscitate the patient, the patient did not survive.The second case is a 58-year-old male involved in a high-speed MVC. Similar to the first case, the patient presented unresponsive, hypotensive and tachycardic with a left sided hemothorax. A chest tube was placed with 900 mL of bloody output. Based on the output and ongoing resuscitation requirements, the patient was taken to the OR. Intraoperatively, a 15 cm anterior pericardial laceration was identified. Through the defect, there was brisk bleeding from a 1 cm laceration on the left atrial appendage. The injury was debrided and repaired using a running 3–0 polypropylene suture over a Satinsky clamp. The patient eventually recovered and was discharged home.ConclusionsWe present two cases of uncontained atrial and pericardial rupture from blunt cardiac trauma. Contained ruptures with an intact pericardium present as a cardiac tamponade while uncontained ruptures present with hemomediastinum or hemothorax. A high degree of suspicion is required to rapidly diagnose and perform the cardiorrhaphy to offer the best chance at survival.

Pringle maneuver during open partial nephrectomy for renal tumors

Introduction. Sparing kidney tissue is important because studies show that patients who have their entire kidney removed are more likely to suffer from chronic kidney disease after surgery than patients who received a kidney-sparing partial nephrectomy. The aim of study is to show the effectives of Pringle maneuver for clamping renal pedicle in order to minimize warm ischemia during open partial nephrectomy. Material and method. We retrospectively analyzed 34 patients diagnosed with cT1 renal tumors between 2012 and 2016 and underwent open partial nephrectomy in Sibiu Urology Department. During the surgery we perform clamping of renal pedicle with Satinsky clamp or with the Pringle maneuver. We analyzed the flowing parameters: operation time, blood loss, clamping time and serum creatinine before and after the surgery. Results. The mean age of patient with partial nephrectomy was 58.7±14.7 years, with 56.7±12.4 years for Satinsky group and 60.5±11.6 for Pringle group. The average duration for partial nephrectomy was 94.8±19.4 minutes. Average blood loss for all surgeries was 220±30 ml. Conclusion. Pringle maneuver is a safe and effective method with low intra and postoperative complications during open partial nephrectomy, having a good control of the renal pedical with reduced ischemia. Is a feasible method of choice in renal tumour tumor pathology on a single congenital or surgical kidney, mediorenal tumors or near the sinus and multifocal tumors.

Use of the Satinsky clamp for hilar clamping during robotic partial nephrectomy: indications, technique, and multi-center outcomes.

A Satinsky clamp may be a backup option for hilar clamping during robotic partial nephrectomy (RPN) if there are challenges with application of bulldog clamps, but there are potential safety concerns. We evaluate outcomes of RPN using Satinsky vs. bulldog clamps, and provide tips for safe use of the Satinsky as a backup option. Using a multi-center database, we identified 1073 patients who underwent RPN between 2006 and 2013, and had information available about method of hilar clamping (bulldog clamp vs. Satinsky clamp). Patient baseline characteristics, tumor features, and perioperative outcomes were compared between the Satinsky and bulldog clamp groups. A Satinsky clamp was used for hilar clamping in 94 (8.8%) RPN cases, and bulldog clamps were used in 979 (91.2%) cases. The use of a Satinsky clamp was associated with greater operative time (198 vs. 175min, p<0.001), estimated blood loss (EBL, 200 vs. 100ml, p<0.001), warm ischemia time (WIT, 20 vs. 19min, p=0.036), transfusion rate (12.8 vs. 4.8%, p=0.001), and hospital stay (3 vs. 2days, p<0.001). Tumor characteristics and number of renal vessels were similar between groups. There were six intraoperative complications in the Satinsky clamp group, but none were directly related to the Satinsky clamp. On multivariable analysis, the use of the Satinsky clamp was not associated with increase in intraoperative or Clavien ≥3 postoperative complications, positive surgical margin rate or percentage change in estimated glomerular filtration rate. A Satinsky clamp can be a backup option for hilar clamping during challenging RPN cases, but requires careful technique, and was rarely necessary.

MP50-15 EVALUATION OF DE NOVO HYPERTENSION AFTER ROBOTIC PARTIAL NEPHRECTOMY: A SINGLE CENTER ANALYSES

You have accessJournal of UrologyKidney Cancer: Evaluation and Staging III1 Apr 2015MP50-15 EVALUATION OF DE NOVO HYPERTENSION AFTER ROBOTIC PARTIAL NEPHRECTOMY: A SINGLE CENTER ANALYSES Oktay Akca, Homayoun Zargar, Peter Caputo, Daniel Ramirez, Riccardo Autorino, Luis Felipe Brandao, Humberto Laydner, Hiury Andrade, Robert J. Stein, and Jihad H. Kaouk Oktay AkcaOktay Akca More articles by this author , Homayoun ZargarHomayoun Zargar More articles by this author , Peter CaputoPeter Caputo More articles by this author , Daniel RamirezDaniel Ramirez More articles by this author , Riccardo AutorinoRiccardo Autorino More articles by this author , Luis Felipe BrandaoLuis Felipe Brandao More articles by this author , Humberto LaydnerHumberto Laydner More articles by this author , Hiury AndradeHiury Andrade More articles by this author , Robert J. SteinRobert J. Stein More articles by this author , and Jihad H. KaoukJihad H. Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2015.02.2926AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES The kidney plays an important role in regulating arterial blood pressure. The aim of this study is to evaluate development of de novo hypertension (HT) in patients who underwent robotic partial nephrectomy (RPN). Further we aimed to identify potential patient and surgery related factors that may contribute to HT after RPN. METHODS Our RPN database of 665 patients, between May 2007 and May 2013, was retrospectively assessed to identify patients with no history of previous HT. This cohort was divided into patient who remained normotensive and patients who developed de-novo HT after surgery. We compared these two groups in terms of demographics, tumor characteristics, perioperative and postoperative findings. RESULTS We identified 211 patients with no HT before RPN surgery. Postoperatively, 34 (16.1%) developed de-novo HT. The use of anti-lipid drug therapy prior to surgery (P=0.016), hospital stay (P=0.03) and use of Satinsky clamp (P=0.001) were significantly different between the two groups. After multivariable analysis, body mass index (BMI) (OR 1.07 (95%CI (1.01,1.14); p=0.04), use of anti-Lipid drugs (OR 2.7 95%CI (1.07,6.67); p=0.03) and use of Satinsky clamp (OR 2.9 95%CI (1.02,8.34); p=0.04) were found to be independent risk factors associated with the development of HT. CONCLUSIONS Patients undergoing RPN may be at risk for the development of HT. Lifestyle and surgical technique may play an important role in the development of de novo HT following RPN. This study identifies BMI and the use of anti-lipid medications as lifestyle dependent factors and the use of Satinsky clamp as a surgical dependent factor for the development of de novo HT following RPN. Comparison of demographics, perioperative findings and postoperative outcomes between Hypertensive and Non-Hypertensive patients Non-Hypertensive De Novo Hypertensive P Patient Number 177 (83.9%) 34 (16.1%) - Age, Mean±SD (years) 49.6±12 53.5±13.6 0.09 BMI, Mean±SD (kg/m2) 28.1±5.8 30±7.3 0.1 ASA, Median (IQR) 2 (2-3) 2 (2-3) 0.7 Pre-Op eGFR, Median (IQR) (mL/min/1.73 m2) 92.8 (83.7-105.9) 90.1 (76.6-107.9) 0.43 DM, n (%) 33 (18.6) 7 (20.8) 0.79 Anti-Lipid Drug Before Surgery 34 (19.2%) 13 (38.2%) 0.016 Renal Score Median (IQR) 7 (5-9) 8 (6-9) 0.46 WIT, Median (IQR) (min) 20 (16-25) 21 (17-28) 0.36 Venous Clamping, N (%) 110 (62.1) 27 (79.4) 0.059 Satinsky, N (%) 31 (17.5) 15 (44.1) 0.001 eGFR preservation 1 year % (IQR) 88.7 (89.2-96.7) 83.5 (69.6-99) 0.22 Time to DeNovo HT Developed, Median (IQR) Days - 373 (130-1118) - © 2015 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 193Issue 4SApril 2015Page: e616-e617 Advertisement Copyright & Permissions© 2015 by American Urological Association Education and Research, Inc.MetricsAuthor Information Oktay Akca More articles by this author Homayoun Zargar More articles by this author Peter Caputo More articles by this author Daniel Ramirez More articles by this author Riccardo Autorino More articles by this author Luis Felipe Brandao More articles by this author Humberto Laydner More articles by this author Hiury Andrade More articles by this author Robert J. Stein More articles by this author Jihad H. Kaouk More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Difficulty in Diagnosis of Leiomyosarcoma of Infrahepatic Inferior Vena Cava

Background: Leiomyosarcomas of inferior vena cava (IVC) are rare tumors that mostly are proposed as a primary malignancy of the IVC. The optimal treatment is completely resects the malignant lesion with preservation of venous return. According to the treated experience of one patient in our hospital, we present our opinions as below. Methods and Results: A 61-year-old woman underwent successful surgical treatment for a leiomyosarcoma with the method of infrahepatic inferior vena cava (IVC). A large tumor that was demonstrated in the Spiegel lobe liver with IVC tumor thrombus was imagined by tomography and magnetic resonance. The tumor was found from IVC, which was performed by suprahepatic and infrahepatic IVC occlusion with Satinskys clamp in the operation. The patient underwent a combined operation which is en bloc resection of the IVC tumor and lobotomy of the left lateral section of liver. Pathological examination confirmed that is primary leiomyosarcoma of the IVC. The patient had a normal live for nearly one year and no recurrence. Conclusion: It is difficult to distinguish leiomyosarcoma from a hepatic tumor. About two thirds of these patients were confirmed as the diagnosis of leiomyosarcomas only after laparotomy. The misdiagnosis to be considered as tumor arising from segment I of the liver with IVC tumor thrombus was lead to the tumor to predominant intra-luminal growth. Radical surgical en bloc resection is the mainly treatment for IVC leiomyosarcomas. Using suprahepatic IVC and infrahepatic IVC occlusion with Satinsky clamp, surgical management of an infrahepatic IVC leiomyosarcoma is a simple vascular surgical techniques.

PE27: Use of the Satinsky clamp in robotic kidney surgery

PE27: Use of the Satinsky clamp in robotic kidney surgery

Open Management of the Renal Vein Is a Safe Modification in Right Sided Laparoscopic Living Donor Nephrectomy.

Study's purpose: The goal of this study was to review the outcome of right sided laparoscopic living donor nephrectomies using a modified technique and to compare them with standard left sided laparoscopic nephrectomies. Methods: Among the 131 patients who underwent LLDN between 12/2005 and 8/2012, 77 underwent a left (group L) and 54 a right (group R)laparoscopic nephrectomy. The two groups were compared with regard to surgical complications, graft function and survival. When performing a right nephrectomy, after complete laparoscopic mobilisation, the two 12mm trokar incisions were connected in a way to create a 7 to 8 cm subcostal incision through wich after tenting the caval vein was partially excluded with a Satinsky clamp under direct vision, the renal vein transected plane with the caval vein and overswen with 4-0 Prolene. Results: No surgical complication and in particular no venous thrombosis was seen in all donors of either side nor in all the recipients. There was no significant difference with regard to graft function (Creatinine levels at discharge group L=1.15±0.40 mg/dL versus group R=1.35±0.54mg/dL, p=0.039). Graft survival at one year was 100% in both groups. Conclusion: Laparoscopic right sided donor nephrectomy with open management of the renal vein is a safe technique providing maximal length of the vein.

Hanging of the Hepatic Veins Septa: A Safe Control Prior and During Outflow Anastomosis in Liver Transplantation

Inferior vena cava (IVC) preservation during orthotopic liver transplantation (OLT) is known as the “piggyback” technique. The end-to-side anastomosis is constructed between the graft's IVC and recipient's hepatic veins using a Satinsky side clamp applied in a transverse position. To stabilize the large Satinsky clamp and preserve a sufficient vascular stump after hepatectomy and before graft implantation, we propose a technical innovation consisting of hanging the septa between the left and middle hepatic vein and between the middle and right hepatic vein using 2 tapes. This technique showed some advantages when performing the caval outflow anastomosis, representing a further technical refinement of the piggyback end-to-side technique for the implantation on the 3 hepatic veins. From November 2001 to September 2012, we performed 272 consecutive OLT at our institution with the piggyback technique using the hanging of the hepatic veins septa in all cases. In conclusion, the hanging of the 3 hepatic veins septa presented in this study represents a simple, safe and reproducible technique for the outflow anastomosis using the piggyback technique.

Comparative Analysis of Vascular Bulldog Clamps Used in Robot-Assisted Partial Nephrectomy

During robot-assisted partial nephrectomy (RAPN) and laparoscopic partial nephrectomy (LPN), clamping of the vascular pedicle before excision of the tumor is the key to minimize blood loss and maintain adequate visualization. Multiple options for hilar control exist, including recently introduced robot-specific bulldog vascular clamps. The relative efficacy of these new clamps has not been assessed. We conducted a comparative analysis of robotic and laparoscopic vascular clamps focusing on clamp force and flow across a clamped model vessel. We compared 10 different vascular clamps used in RAPN and LPN: The Klein robotic; Klein laparoscopic short, medium straight, medium curved, and long; Aesculap short straight, short curved, long straight and long curved; and a laparoscopic Satinsky clamp. Force testing was performed at 1 cm and 2 cm distances from the fulcrum and at the tip. To simulate a clamped vessel, a quarter inch Penrose was clamped and the proximal end attached to a pressure flow monitor. Flow across the tubing at various pressures and leak point pressure (LPP) were recorded. Comparative analysis was conducted using descriptive statistics and t tests. The Klein robotic clamp exerted significantly less clamp force along the length of the clamp compared with the laparoscopic placed Klein, Aesculap, and Satinsky clamps (P<0.001). In our vascular model, the Klein robotic clamp had a LPP of 8.3 mm Hg vs 36.3 mm Hg (Klein lap) and >170 mm Hg (Aesculap) (P<0.001). At all pressures, the robotic clamp allowed more flow compared with laparoscopic clamps. Robotic vascular bulldog clamps produce significantly less clamping force than laparoscopic bulldog or Satinksy clamps and thus allow more flow across the clamped segment. This difference appears to be intrinsic to the clamp itself. This may translate into poorer hemostasis intraoperatively.