Soft-coagulation System Research Articles

Effectiveness of soft coagulation in robot-assisted partial nephrectomy in preventing pseudoaneurysms and its influence on renal function based on propensity score-matched analysis.

Renal artery pseudoaneurysm (RAP) is one of the most stressful and life-threatening complications of partial nephrectomy, the standard treatment for small renal cell carcinoma. The use of a monopolar soft coagulation system for hemostasis during robot-assisted partial nephrectomy (RAPN) is expected to prevent post-surgical RAP development. In this study, we aimed to investigate how the use of a soft coagulation system in RAPN reduces postoperative pseudoaneurysms and changes renal function over time. The incidence of pseudoaneurysms and postoperative renal function were compared in 208 partial nephrectomies performed between May 2016 and March 2023 at a single institution, with propensity score matching to balance patient backgrounds. Outcomes were analyzed using multivariate logistic or linear regression analyses. In total, 80 matched pairs were analyzed. One (1.2%) and eighteen (22.5%) pseudoaneurysms were found in the soft coagulation users and non-users, respectively (P<0.001). Compared to the non-user group, postoperative estimated glomerular filtration rates (eGFRs) in the user group were 89% vs. 96% (P<0.001), 87% vs. 93% (P=0.009), and 88% vs. 92% (P=0.15) at 1, 3, and 12 months, respectively. Subsequent multivariate analyses showed a lower incidence of pseudoaneurysms in the user group with an odds ratio of 0.05 [95% confidence interval (CI): 0.01 to 0.44; P=0.007], and no significant difference in the rate of change in renal function at 12 months postoperatively (-1.1%, 95% CI: -5.5% to 3.3%; P=0.61). The use of a soft coagulation system reduces pseudoaneurysm occurrence after partial nephrectomy. Although renal function decreased in the short-term for the use group, no long-term differences were observed.

Blunt dissection method using HiQ+ soft coagulation system for laparoscopic cholecystectomy in acute cholecystitis.

During laparoscopic cholecystectomy for acute cholecystitis, it is often difficult to keep the surgical view dry because of inflammation-related tissue fragility and susceptibility to bleeding. The resulting inadequate surgical view can lead to bile duct or vascular injury. Soft coagulation systems are used to achieve hemostasis during various surgeries; however, the usefulness of soft coagulation during laparoscopic cholecystectomy for acute cholecystitis is unclear. We here demonstrate the usefulness and feasibility of blunt dissection and soft coagulation during this procedure. We used blunt dissection and soft coagulation when performing laparoscopic cholecystectomy on two patients with acute cholecystitis. As with conventional laparoscopic cholecystectomy, four ports were inserted. After cutting the serosa by electrocautery, blunt dissection using soft coagulation was performed, exposing the inner subserosa. Maintaining this layer using blunt dissection with soft coagulation achieved a sufficiently clear view for safety. After resecting the cystic artery and duct, the gallbladder bed was also dissected by blunt dissection with soft coagulation. Blood loss was <20 mL in both patients. Blunt dissection with soft coagulation may be a useful and feasible means of keeping the surgical view dry and minimizing blood loss during laparoscopic cholecystectomy for acute cholecystitis.

Robotic free pericardial fat pledget technique for treating pulmonary air leak.

There is no clear evidence for the ideal technique for treating intraoperative air leak. A previous study showed that the VIO soft-coagulation system (VIO 300D system; Erbe Elektromedizin) is useful for minor air leaks, as the automatically adjusted voltage output does so without causing sparks or tissue carbonization, resulting in covering the pulmonary fistula with a fibrin membrane.1 Although suturing is required to treat deeper lung injuries, simple suturing of emphysematous lungs may induce further lung injury.

Clinical effect of soft coagulation for air leak treatment during pulmonary lobectomy

BackgroundSoft coagulation using the VIO soft coagulation system is used to treat minor lung air leaks during pulmonary resection in Japan. We previously reported that it has a similar effect as the air leak treatment with fibrin glue. We evaluated the efficacy of soft coagulation using the VIO soft coagulation system for lung air leakage during pulmonary resection.MethodsIntraoperative air leaks from the interlobar lung parenchyma were observed in 42 of the 283 patients who underwent video-assisted thoracoscopic surgery lobectomy between 2016 and 2018. We retrospectively reviewed these 42 patients who were treated using the VIO soft coagulation system for air leaks. We classified the air leaks in to grades using the Macchiarini scale score and evaluated the surgical outcomes of air leak treatment.ResultsAir leaks from the interlobar lung parenchyma having Macchiarini scale scores 1, 2, and 3 occurred in 8, 17, and 17 patients, respectively. In all the 8 patients with score 1 air leaks (100%), the air leaks could be controlled using the VIO soft coagulation system alone, and none had delayed pneumothorax requiring intervention. Of the score 2 and 3 air leaks, 52.9% and 35.3% were controlled using the VIO soft coagulation system alone, respectively.ConclusionsMacchiarini scale score 1 air leaks from the interlobar lung parenchyma could be well controlled using the VIO soft coagulation system. Therefore, soft coagulation with this system may be an alternative method for treating minor air leaks during pulmonary resection surgery.

Predictive factors for postoperative renal function after off-clamp, non-renorrhaphy partial nephrectomy.

BackgroundThere is limited information on perioperative renal function during off-clamp, non-renorrhaphy open partial nephrectomy. Therefore, this retrospective study aimed to identify predictive factors of perioperative decline in renal function after off-clamp, non-renorrhaphy open partial nephrectomy.MethodsClinical records of 138 patients with renal tumors who underwent off-clamp, non-renorrhaphy open partial nephrectomy at our institution were reviewed. Off-clamp, non-renorrhaphy partial nephrectomy was performed using a soft coagulation system. Perioperative estimated glomerular filtration rate (eGFR) preservation was calculated, and predictors were identified using multivariate regression analysis at 5 days, 1 month, and 3 months after surgery.ResultsThe median operation time was 122 minutes, and the median volume of estimated blood loss was 155 mL. The mean eGFR preservation at 5 days, 1 month, and 3 months after surgery was 95.3%, 91.0%, and 90.7%, respectively. Estimated blood loss was an independent predictor of perioperative decline in eGFR 5 days after surgery [odds ratio (OR): 0.97; 95% confidence interval (CI): 0.96, 0.98; P<0.001]. Preoperative eGFR and estimated blood loss were independent predictors of perioperative decline in eGFR 1 month after surgery (OR: 0.86; 95% CI: 0.77, 0.95; P=0.007 and OR: 0.98; 95% CI: 0.97, 0.99; P<0.001, respectively). Age, preoperative eGFR, and estimated blood loss were independent predictors of perioperative decline in eGFR 3 months after surgery (OR: 0.64; 95% CI: 0.54, 0.81; P<0.001, OR: 0.72; 95% CI: 0.61, 0.85; P<0.001; and OR: 0.98; 95% CI: 0.97, 0.99; P=0.004, respectively).ConclusionsEstimated blood loss during surgery was a predictor of perioperative decline in eGFR within 3 months after off-clamp, non-renorrhaphy open partial nephrectomy. Age was a predictor of perioperative decline in eGFR 3 months after surgery.

Delayed bronchial perforation after bulla cauterization with soft coagulation system

BackgroundSoft coagulation is widely used for hemostasis because of its significant advantage in inducing tissue coagulation and denaturation without carbonization. However, a few cases of airway damage have been reported at the site, where soft coagulation was directly applied.Case presentationWe encountered an unusual case of delayed perforation of the intermediate bronchial trunk observed on 24 days after cauterization of the right S6 bulla adjacent to the bronchus. Chest computed tomography revealed a large fistula between the intermediate bronchial trunk and the cauterized bulla in the right S6. Bronchoscopy showed a large fistula at the membranous portion of the intermediate bronchial trunk. We presumed that the bronchial perforation resulted from thermal damage to the intermediate bronchial trunk during bulla cauterization and the bronchial perforation induced infection in the bulla. Resection of the infectious bulla and the intermediate bronchial trunk, followed by end-to-end bronchial anastomosis and a pedicled intercostal muscle flap coverage, was performed.ConclusionsThe severe airway damage resulting in perforation developed even without direct contact between the electrode tip and the bronchial wall, provoking the need for special attention to the duration of cauterization and location, where it is used.

Assessment of surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy for ≥T1b renal tumours.

To assess the surgical outcomes of off-clamp open partial nephrectomy without renorrhaphy. In the era of robot-assisted surgeries, open partial nephrectomy remains a surgical option for ≥ T1b renal tumours. Although the necessity of renal pedicle clamping and renorrhaphy in open partial nephrectomy for larger tumours remains to be discussed, reports on this issue are rare. Twenty-seven open partial nephrectomies for ≥ T1b renal tumours were performed without renal pedicle clamping or renorrhaphy. A soft coagulation system was used to control bleeding from the resection bed. Surgical results, complications, and predictors of perioperative estimated glomerular filtration rate (eGFR) preservation at 1month and 3months after surgery were analysed. The median estimated volume of blood loss was 420mL. The rates of perioperative eGFR preservation were 88.9 and 87.3% at 1 and 3months after surgery, respectively. Tumour size was an independent predictor of perioperative eGFR preservation at 1month after surgery, whereas age and exophytic/endophytic properties of the tumour were independent predictors of perioperative eGFR preservation at 3months after surgery. Open partial nephrectomy without renal pedicle clamping or renorrhaphy could be safely performed for ≥ T1b renal tumours, even when tumours were entirely endophytic and located close to the renal pedicle. Mild perioperative eGFR reduction was observed. Although surgical indications should be carefully considered in these cases, off-clamp open partial nephrectomy without renorrhaphy is a feasible procedure for patients with ≥ T1b renal tumours.

Efficiency of a radiofrequency sealer (Aquamantys) for parenchymal transection during laparoscopic hepatectomy.

The methods of liver parenchymal transection vary across institutions. In this study, we used a radiofrequency (RF) sealer (Aquamantys) as a hemostatic device during laparoscopic liver transection; we also evaluated the usefulness of RF sealers. From April 2016 to May 2019, 113 consecutive laparoscopic hepatectomy patients, excluding patients with combined resection of other organs, were examined. Patient characteristics, operative factors, and postoperative complications were compared between the Cavitron ultrasonic surgical aspirator (CUSA) + soft coagulation system (VIO) group; (n = 32) and the CUSA + Aquamantys group; (n = 81). The former underwent liver transection by CUSA and VIO from April 2016 to March 2017, while the latter underwent liver transection using CUSA and Aquamantys from April 2017 to May 2019. The median difficulty score was significantly higher in the CUSA + VIO group (5.5 points vs 5.0 points; P = .04). Blood loss per unit area and the liver parenchymal transection speed were not significantly different between the groups. After propensity score matching, blood loss per unit area was similar between the groups, but the parenchymal transection speed of the CUSA + Aquamantys group was significantly higher (0.92 cm2 /min vs 0.64 cm2 /min; P = .017). Postoperative complications were similar between the groups. In laparoscopic hepatectomy, hemostasis of the transection plane with an RF sealer did not reduce blood loss during parenchymal transection. However, the liver parenchymal transection speed was increased.

Absence of asymptomatic unruptured renal artery pseudoaneurysm on contrast-enhanced computed tomography after robot-assisted partial nephrectomy without parenchymal renorrhaphy

ObjectiveTo assess the incidence of asymptomatic unruptured renal artery pseudoaneurysm (RAP) on contrast-enhanced computed tomography (CE-CT) after robot-assisted partial nephrectomy (RAPN) without parenchymal renorrhaphy. MethodsFrom May 2016 to December 2017, 78 patients underwent RAPN for renal tumors. Inner suture was performed in the opened collecting system or renal sinus, whereas parenchymal renorrhaphy was not. For hemostasis, the soft coagulation system was used, and absorbable hemostats were placed on the resection bed. CE-CT was carried out within 7 days after surgery. Data on these patients were prospectively collected. A single radiologist determined the diagnosis of RAP. ResultsMedian (range) data were as follows: Patient age, 65 (19–82) years; radiographic tumor size, 30 (12–95) mm; operating time, 166 (102–294) min; warm ischemic time, 16 (7–67) min; and blood loss, 15 (0–4450) mL. One patient (1.6%) required a perioperative blood transfusion. No patient required conversion to open surgery or nephrectomy. CE-CT was carried out at median 6 (3–7) days after surgery. CE-CT showed no RAP development in all 61 patients. Urinary leakage was not observed. One patient had acute cholecystitis, a postoperative complication classified as Clavien-Dindo grade higher than 3, which was treated with cholecystectomy. Positive surgical margin was identified in four patients (6.6%). ConclusionRAPN using soft coagulation and absorbable hemostats without renorrhaphy appears to be feasible and safe. Our technique could eliminate the risk of RAP.

IJU this issue

This issue of International Journal of Urology contains two Review Articles, eight Original Articles and six Urological Notes. Tanaka et al. (Osaka, Japan) reviewed the current topics and trends of hyperbaric oxygen (HBO) therapies in urological diseases. HBO therapy can be an effective option for treating some urological conditions, including radiation-induced hemorrhagic cystitis, Fournier gangrene and interstitial cystitis. In the past, there have been concerns about whether HBO could accelerate cancer cell growth through increased oxygen delivery. However, previous studies concluded that HBO did not promote cancer aggressiveness and that HBO was a safe treatment for cancer patients. This is good news for many urological physicians. Ito (Tokorozawa, Japan) reviewed recent advances in the systemic treatment of metastatic non-clear cell renal cell carcinomas (nccRCCs). At present, there is no standard treatment for metastatic nccRCCs. There are various types of nccRCCs with different genetic backgrounds and molecular features. Currently, tyrosine kinase inhibitors are a treatment option for metastatic papillary RCC as both first-line and second-line agents, whereas both tyrosine kinase inhibitors and mammalian target of rapamycin inhibitors can be applicable for metastatic chromophobe RCC. However, further evidence is required to clarify appropriate therapeutic strategies for nccRCC using new agents and combination regimens. In the Original Articles, Tohi et al. (Kobe, Japan) assessed the perioperative outcomes of robot-assisted partial nephrectomy without renorrhaphy for cT1b renal tumors compared with cT1a. They concluded that robot-assisted partial nephrectomy without renorrhaphy using the soft-coagulation system and absorbable hemostats appears to be feasible for cT1b tumors, although longer warm ischemic time and a high rate of complications can be expected compared with cT1a tumors. It is notable that pseudoaneurysm occurred in none of the 66 patients with cT1a tumors and only one of the 34 patients with cT1b tumors. Okumi et al. (Tokyo, Japan) investigated biopsy-proven recurrence rates and risk factors for immunoglobulin A nephropathy recurrence in 299 kidney transplant recipients. The 10-year recurrence rate was 34%. Related-donor transplantation and post-transplant increased proteinuria were identified as potential risk factors for recurrence. The results have clinical implications in that the signs of recurrent immunoglobulin A nephropathy should be evaluated carefully in recipients receiving related-donor transplants. In the Urological Notes, Suzuki et al. (Tokyo, Japan) reported penile size and stretched rate in a Japanese male population using fresh cadavers. This is a unique study. As Fukuhara (Osaka, Japan) described in the Editorial Comment, penile size is an important factor for men to have a better self-image and better satisfaction during sexual activity. This study provides on-demand helpful data to urologists, because there is scarce knowledge in this field. Yamada et al. (Kyoto, Japan) investigated the feasibility of virtual reality for surgical planning and intraoperative management in partial nephrectomy. Virtual reality technology allows the surgeon to understand the patient's anatomy more accurately and plan the surgical procedures with more care. Although the objective usefulness of the case-specific 3-D virtual reality-based surgical simulation is not shown, it can be a useful technique to intuitively understand surgical anatomy and facilitate surgical decision-making in partial nephrectomy. Unfortunately, the limited space does not allow me to introduce all the articles. However, all the papers are very interesting and informative. Please enjoy this issue of International Journal of Urology. None declared.

Off-Clamp, Non-Renorrhaphy Robot-Assisted Partial Nephrectomy : An Initial Experience in a Single Institution

We report the surgical procedures and perioperative outcomes of off-clamp, non-renorrhaphy robotassisted partial nephrectomy (RAPN) in 7 out of 76 patients who underwent RAPN with off-clamp and nonrenorrhaphy between February 2015 and August 2017. The approach was chosen depending on the location of the tumor. Tumor enucleation was performed by using sharp incision and blunt dissection. For hemostasis, the soft-coagulation system was used and TachoSil○R was placed on the resection bed. As a rule, renorrhaphy was not performed. Median (range) patient age was 67 years (40-79), tumor size ; 14 mm (12-18), operative time ; 139 minutes (102-166), console time ; 51 minutes (41-75), estimate blood loss ; 10 ml (0-100). No patients required a perioperative blood transfusion. Median (range) tumor intraparenchymal depth was 10.4 mm (4.3-15.5) and distance from urinary collecting system was 9.3 mm (4.1-13.0). Pseudoaneurysm and urine leakage were not observed. No complications classified as Clavien-Dindo grade higher than grade 1 appeared. No cases had a positive surgical margin. Median (range) estimated glomerular filtration rate (eGFR) change rate at 3 months after surgery was 0% (-12.7-14.5). Off-clamp, non-renorrhaphy RAPN with the soft-coagulation system and TachoSil® is a feasible and safe procedure for patients carefully selected among those with superficial tumors.

MP42-05 ACUTE KIDNEY INJURY AND INTERMEDIATE-TERM RENAL FUNCTION AFTER CLAMPLESS PARTIAL NEPHRECTOMY

You have accessJournal of UrologyKidney Cancer: Localized: Surgical Therapy IV1 Apr 2018MP42-05 ACUTE KIDNEY INJURY AND INTERMEDIATE-TERM RENAL FUNCTION AFTER CLAMPLESS PARTIAL NEPHRECTOMY Minato Yokoyama, Naoko Kawamura, Sho Uehara, Yosuke Yasuda, Toshiki Kijima, Soichiro Yoshida, Junichiro Ishioka, Yoh Matsuoka, Kazutaka Saito, Kazunori Kihara, and Yasuhisa Fujii Minato YokoyamaMinato Yokoyama More articles by this author , Naoko KawamuraNaoko Kawamura More articles by this author , Sho UeharaSho Uehara More articles by this author , Yosuke YasudaYosuke Yasuda More articles by this author , Toshiki KijimaToshiki Kijima More articles by this author , Soichiro YoshidaSoichiro Yoshida More articles by this author , Junichiro IshiokaJunichiro Ishioka More articles by this author , Yoh MatsuokaYoh Matsuoka More articles by this author , Kazutaka SaitoKazutaka Saito More articles by this author , Kazunori KiharaKazunori Kihara More articles by this author , and Yasuhisa FujiiYasuhisa Fujii More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2018.02.1312AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Some patients experience acute kidney injury (AKI) after partial nephrectomy (PN). The incidence of AKI after PN with hilar clamping has been reported in several studies, and some investigators demonstrated the association of duration or type of ischemia with the incidence of AKI. However, the incidence of AKI after clampless PN and the influence of AKI after PN on longitudinal change in postoperative renal function have not been fully explored. Here, we investigated associations between AKI and intermediate-term renal function after clampless PN. METHODS Between 2010 and 2015, 337 consecutive patients underwent gasless single-port PN and were followed up longer than 1 year. In this surgery, PN was done with an extraperitoneal approach via a single-port without gas insufflation and hilar clamping by using soft coagulation and ultrasonic coagulation system. Of the 337 patients, those with bilateral tumors (n=26), metastases (n=6), solitary kidney (n=4), and those requiring hilar clamping (n=21) were excluded. The association between the occurrence of AKI based on AKI network definition and renal impairment with ≥25% estimated glomerular filtration rate (eGFR) decrease was evaluated using Cox regression model.Then, mean eGFRs of the patients with or without AKI after clampless PN up to 5 years were plotted, and an annual change of eGFR from 1 year after surgery was calculated using linear mixed model. RESULTS Of the 280 patients, Median age, preoperative eGFR, tumor size, operation time, and blood loss was 58 years, 70.6 ml/min/1.73 m2, 2.5 cm, 214 minutes, and 314 ml, respectively. Hypertension, diabetes mellitus, dyslipidemia, and cardiovascular disease coexisted in 38%, 10%, 15%, and 9% of the subjects, respectively. AKI occurred in 21 patients (8%), and all the AKIs observed were grade 1. Median eGFR change at latest follow up (median 36 months) was -9.0%. During the follow up period, no patients required renal replacement therapy.Cox regression analysis showed that AKI was not associated with renal impairment after clampless PN, while advanced age (≥65) and presence of diabetes mellitus were independent risk factors.Annual eGFR changes from 1 year after clampless PN in patients with and without AKI were -0.34 (95% CI: -1.23 ~ 0.54) ml/min/1.73 m2 and -0.36 (-0.72 ~ -0.02) ml/min/1.73 m2, respectively. CONCLUSIONS Renal function was well preserved after clampless PN. The incidence and severity of AKI were low, and AKI after clampless PN was not associated with intermediate-term renal impairment. © 2018FiguresReferencesRelatedDetails Volume 199Issue 4SApril 2018Page: e537-e538 Advertisement Copyright & Permissions© 2018MetricsAuthor Information Minato Yokoyama More articles by this author Naoko Kawamura More articles by this author Sho Uehara More articles by this author Yosuke Yasuda More articles by this author Toshiki Kijima More articles by this author Soichiro Yoshida More articles by this author Junichiro Ishioka More articles by this author Yoh Matsuoka More articles by this author Kazutaka Saito More articles by this author Kazunori Kihara More articles by this author Yasuhisa Fujii More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Significance of a soft-coagulation system with monopolar electrode for hepatectomy: A retrospective two-institution study by propensity analysis

BackgroundThe VIO soft-coagulation system (VIO) with a monopolar electrode is a novel hemostatic device that provides hemostasis by superficial contact at the bleeding site without carbonization. Because heat injury remains a concern, surgical records and postoperative liver dysfunction were retrospectively evaluated in a cohort study. MethodsBetween September 2010 and March 2016, 322 patients underwent hepatectomy in which hemostatic devices were used at two institutions. Surgical results with use of VIO at one institute (VIO group) were compared with those without use of VIO at a second institute (control group), and propensity analysis was performed. ResultsIn limited resection and segmentectomy or sectionectomy performed in the VIO group, the prevalence of liver cirrhosis was significantly higher and the operation time was significantly longer in comparison with the control group (p < 0.05). In all hepatectomies, postoperative levels of total bilirubin and aspartate or alanine transaminase tended to be increased and prothrombin activity tended to be lower in the VIO group in comparison with the control group (p < 0.05). The prevalence of hepatic failure in the VIO group was significantly higher in comparison with that in the control group (p < 0.05). In cases of segmentectomy or sectionectomy, blood loss was significantly increased in the VIO group in comparison with that in the control group (p < 0.05) Propensity score matching showed that although the surgical records and outcomes were not significantly different between the groups, postoperative liver dysfunction was significant in the VIO group in comparison with the control group (p < 0.05). ConclusionsMild postoperative hepatic thermal injury with VIO was confirmed, and therefore, surgeons should take care when using the VIO system to make frequent wide resected cuts on the surface of the liver.

ソフト凝固装置による副腎止血時に異常高血圧を認めた2例

ソフト凝固装置による副腎止血時に異常高血圧を認めた2例

Improvement of surgical results by VIO soft-coagulation system in hepatocellular carcinoma patients who underwent elective hepatectomy

Aim and methods: VIO soft-coagulation system is a new generation hemostatic device and surgical results in case of hepatocellular carcinoma (HCC) patients undergoing 335 elective hepatectomy was historically and retrospectively analyzed between 2002 and March 2015. Other hemostatic and cutting devices were also used. Surgical results between VIO-system group (n = 122) and non-VIO (control) group (n = 213) was compared. Results: VIO system was applied since 2010 and its use has been gradually increased (10% in 2010, 55% in 2011 100% since 2012). Age, gender and type of hepatectomy were similar between groups. Although prevalence of the Japanese liver damage grade BC (poorer liver function) in VIO group (n = 19;16%) tended to be lower in comparison with that in control (n = 63;30%) and, however, prevalence of cirrhosis in VIO group (n = 49;40%) was significantly higher than that in control group (n = 113;53%)(p < 0.05). Mean blood loss in VIO group (1041 ml) was significantly lower in comparison with control group (1881 ml)(p < 0.01) and operating time in VIO group (387minutes) was significantly lower in comparison with control group (451minutes)(p < 0.01). Although prevalence of bile leakage and total postoperative morbidity were not significantly different, prevalence of intraabdominal infectious fluid collection in VIO group (n = 9; 7.4%) was higher than that in control group (n = 6;2.8%) (p = 0.05). Eventually, hospital stay duration in VIO (17.9days) was significantly lower in comparison with control group (19.5days) (p < 0.01). Conclusion: VIO system has been frequently used recently because of better surgical records even n case of cirrhosis and, however, abscess formation due to hepatic heat injuries must be concerned.

V5-07 A NOVEL TECHNIQUE OF NON-TISSUE SUTURING LAPAROSCOPIC PARTIAL NEPHRECTOMY WITHOUT THE RENORRHAPHY

You have accessJournal of UrologyRenal Oncology1 Apr 2016V5-07 A NOVEL TECHNIQUE OF NON-TISSUE SUTURING LAPAROSCOPIC PARTIAL NEPHRECTOMY WITHOUT THE RENORRHAPHY Nobuyuki Fukuzawa, Hiroshi Tanaka, Madoka Higuchi, Hidetaka Suzuki, Ai Kawaguchi, Shintaro Maru, Tomoshige Akino, Yoshiki Wada, Hiroshi Harada, and Toshimori Seki Nobuyuki FukuzawaNobuyuki Fukuzawa More articles by this author , Hiroshi TanakaHiroshi Tanaka More articles by this author , Madoka HiguchiMadoka Higuchi More articles by this author , Hidetaka SuzukiHidetaka Suzuki More articles by this author , Ai KawaguchiAi Kawaguchi More articles by this author , Shintaro MaruShintaro Maru More articles by this author , Tomoshige AkinoTomoshige Akino More articles by this author , Yoshiki WadaYoshiki Wada More articles by this author , Hiroshi HaradaHiroshi Harada More articles by this author , and Toshimori SekiToshimori Seki More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.250AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic partial nephrectomy (LPN) has been commonly performed to spare as much as nephron mass, however, renal ischemic time is problematic. Furthermore, conventional suturing technique has potential to produce post-operative pseudo aneurysm and subsequent abrupt bleeding. We introduced a novel non-tissue suturing laparoscopic partial nephrectomy (NTS-LPN) and compared clinical outcomes with conventional laparoscopic partial nephrectomy (C-LPN) in our institution. METHODS A hundred-eighty five patients who underwent partial nephrectomy since 2004 were divided between NTS-LPN group (NTS) (n=98) and C-LPN group (C) (n=87). The surgical maneuver of NTS differs with C after excising tumor with renal artery clamping. The resected surface was simply coagulated using a soft-coagulation system (a VIOTM system and an IO electrodeTM) without parenchyma suturing. After declamping, a TachoSil® is attached on coagulated surface. Perioperative data including the parenchymal volume of postoperative renal ischemic volume (PRIV) and the change of residual renal volume (RRV) calculated by 3D-CT volumetry, postoperative kidney function and adverse events were compared between 2 groups. RESULTS Mean operative time and renal ischemic time in NTS (146±34.0min/15.6±7.45min) were dramatically shortened as compared to those in C (236±77.8min/54.8±27.4min). Mean operative blood loss was similar between NTS (43.3±61.5ml) and C (65.9±91.9ml). Renal parenchymal damage as shown PRIV was significantly less in NTS group than that in C at the point of postoperative 3, 6, 12 months (NTS: 4.26±2.29ml, 2.37±1.02ml, 1.67±0.55ml / C: 19.4±5.49ml, 15.9±8.20ml, 13.1±6.00ml). Renal atrophy as shown RRV postoperative 3, 6, 12 months was also significantly less in NTS than that in C (p<0.01). No positive surgical margin was observed in NTS, but only one case in C. Serum creatinine values of each point (1/3/6/12 months) were comparable in both groups. According to Clavien-Dindo classification, major complications of IIIa (postoperative bleeding, minor urinary leakage and peri-renal abscess) were observed in C, whereas 2 cases of minor urinary leakage in NTS. In addition, 6 cases of pseudo aneurysm were only observed in C. CONCLUSIONS A novel technique of NTS-LPS could spare operative and ischemic time and nephron loss as well without increasing invasiveness compared with conventional tissue-suturing partial nephrectomy. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e595-e596 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Nobuyuki Fukuzawa More articles by this author Hiroshi Tanaka More articles by this author Madoka Higuchi More articles by this author Hidetaka Suzuki More articles by this author Ai Kawaguchi More articles by this author Shintaro Maru More articles by this author Tomoshige Akino More articles by this author Yoshiki Wada More articles by this author Hiroshi Harada More articles by this author Toshimori Seki More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Incidental bronchial injury by soft coagulation.

Soft coagulation is a hemostat system of electrosurgical units, which automatically regulates its output voltage below 200 V, to avoid excessive output that causes carbonization of the target tissue. However, this new minimally invasive technology still has the potential risk of tissue damage during surgery. We encountered three patients with bronchial injury caused by the above system; one of whom had bronchopleural fistula. This is believed to be the first report emphasizing the adverse effects of the soft coagulation system in thoracic surgery, giving a warning to the application of this convenient device.

Efficacy of Hemostasis for Epidural Venous Plexus and Safety for Neural Structure Using Soft Coagulation System in Spinal Surgery

A laboratory investigation using porcine model. To clarify the effectiveness of the soft coagulation system for stopping bleeding from the epidural vein using different outputs and the safety in terms of tissue damage including spinal cord injury. Problems associated with coagulation using an electrosurgical device, such as carbonization of tissue or adhesion to the electrode, have been highlighted. So called "soft coagulation" has been developed to solve these problems. Its' utility as well as the safety of the neural structure in spine surgery has never been reported. A total of 3 animals and 45 spinal segments were used. Total laminectomy was performed to expose the dural tube and epidural venous plexus. Stable bleeding was induced by a 22 G needle puncture. Soft coagulation monopolar output (SCM), soft coagulation bipolar output (SCB), and conventional bipolar output (CB) were used as the coagulators. Valid hemostasis was defined as macroscopically complete bleeding stoppage by coagulation within 3 minutes. The neurological assessment was evaluated by somatosensory evoked potential. Histologic analysis was performed to determine the area of thermal damage. Valid hemostasis ratio was 75.0% of SCM group, 68.8% of SCB group, and 30.8% of CB group. Somatosensory evoked potential monitoring revealed that spinal cord injury was observed in 4 lesions (25%) of the SCM group. Neither bipolar groups (SCB and CB) showed any changes in waveform pattern. Histologic analysis revealed that severe thermal damages were observed in the epidural space of the SCM group. The usefulness of soft coagulation is revealed in terms of bleeding stoppage from epidural vessels and reduced soft-tissue damage compared with the conventional electric device. However, assessing the potential risk of severe neural tissue damage including spinal cord injury, a bipolar soft coagulation is strongly recommended for use in spine surgery.

マイクロ波やソフト凝固システムを用いた腹腔鏡下肝切除術の適応拡大

Although laparoscopic liver resection has been gradually accepted as a treatment of choice for benign and malignant hepatic diseases, it is necessary to use effective hemostatic device to safety enlarge the indications of laparoscopic liver resection. We have been expanded the use of laparoscopic liver resection by selecting effective hemostatic device: microwave pre-coagulation and soft-coagulation system. In the laparoscopic limited liver resection for the patient with severe liver cirrhosis, we usually use pre-coagulation technique with Microtaze® to control bleeding from the cirrhotic liver. On the other hand, in the laparoscopic anatomical liver resection of non-cirrhotic liver, we use Sonosurg® for the surface of the liver and laparoscopic surgical aspirator and monopolar forceps using soft-coagulation with saline dripping. Selecting proper hemostatic devices based on the conditions of liver is important for safe laparoscopic liver resection.

Liver Resection using a Soft-Coagulation System without the Pringle Maneuver

The Pringle maneuver is generally performed to reduce the amount of blood loss during hepatic resection. We have developed a method to sufficiently control blood loss during hepatectomy without applying the Pringle maneuver. This study was performed to determine the safety and operative blood loss in hepatectomy performed by this new method. We performed 102 hepatic resections without the Pringle maneuver. We retrospectively compared the short-term operative outcome between these 102 cases and another 75 hepatic resections performed with the Pringle maneuver. The resections without the Pringle maneuver were performed using a soft-coagulation system. The median length of the surgery using the soft-coagulation system without the Pringle maneuver was 135 minutes, significantly shorter than the surgical time required for resection with the Pringle maneuver 297 minutes (p<0.001). The median volume of operative blood loss was significantly lower in the non-Pringle-maneuver group (200cc vs. 704cc; p<0.001). Regarding postoperative liver function, AST, ALT, T-Bil and PT, levels were all significantly improved in the non-Pringle-maneuver group (p<0.01). Our data suggest that hepatic resection using a soft-coagulation system without the Pringle maneuver is extremely safe and effective in controlling bleeding.