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Inicio Actas Urológicas Españolas (English Edition) Haemostasis control during laparoscopic partial nephrectomy without parenchymal ...
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Vol. 37. Issue 1.
Pages 47-53 (January 2013)
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Vol. 37. Issue 1.
Pages 47-53 (January 2013)
Surgical Technique
Haemostasis control during laparoscopic partial nephrectomy without parenchymal renorrhaphy: The Vivostat® experience
Control de la hemostasia durante la nefrectomía parcial laparoscópica sin renorrafia parenquimatosa: la experiencia Vivostat®
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M. Hevia, J.M. Abascal-Junquera
Corresponding author
jmabascalj@gmail.com

Corresponding Author.
, R. Sacristán, J. Suárez, B. Lobo, S. Méndez, P. Pellejero, R. Abascal-García
Servicio de Urología, Hospital Universitario Central de Asturias, Oviedo, Spain
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Table 1. Preoperative and postoperative data.
Table 2. Current series published on laparoscopic partial nephrectomies.
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Abstract
Objective

To present our experience using an autologous fibrin sealant prepared with the Vivostat system® to control haemostasis without any renal parenchymal reconstruction.

Material and methods

We performed 45 laparoscopic partial nephrectomies using this haemostatic agent. The surgical steps were: colon mobilization, identification of ureter, renal vessels and renal tumor, renal artery control with Rummel tourniquet, tumor excision with harmonic scalpel, and application of fibrin glue to the resection bed twice (before and after kidney reperfusion). Patients were evaluated for acute or delayed bleeding.

Results

Mean age was 63.9 years (33–80); mean tumor size was 2.5cm (1.5–4); mean operative time was 136.1min (90–180). Mean warm ischemia time was 19.2min (10–30). Mean blood loss was 97ml (50–300). Individual haemostatic stitches were performed before application of the sealant if acute bleeding was observed (14 cases). We did not record any case of postoperative bleeding or renal failure. One patient required transfusion due to a big hematoma on the abdominal wall. 65% were clear cell carcinoma, 10% were papillary carcinoma, 20% were oncocitoma. Free margin rate was 100%. Mean hospital stay was 4 days (2–6). Mean follow-up was 14 months (5–45).

Conclusions

Excluding renorrhaphy during laparoscopic partial nephrectomy is feasible and safe. Our initial experience with the vivostat system in laparoscopic partial nephrectomy has been encouraging, but longer follow-up is needed to determine the real benefit of this surgical technique in laparoscopic partial nephrectomy.

Keywords:
Laparoscopic partial nephrectomy
Fibrin glue (Vivostat System®)
Hemostasis
Resumen
Objetivo

Presentar nuestra experiencia en el control hemostático de la nefrectomía parcial laparoscópica utilizando un compuesto de fibrina autóloga (Vivostat system®), sin reconstrucción del parénquima renal.

Material y métodos

Hemos realizado 45 nefrectomías parciales utilizando este agente hemostático. Los principales pasos quirúrgicos fueron: decolación, identificación del uréter, hilio y tumoración renal, control de la arteria renal con torniquete de Rummel, exéresis tumoral con bisturí armónico y aplicación del sellador de fibrina en el lecho quirúrgico en 2 fases (antes y después de la reperfusión renal). Se registraron datos de sangrado precoz o diferido.

Resultados

Edad media: 63,9 años (33-80); tamaño medio del tumor 2,5cm (1,5-4); tiempo medio quirúrgico: 136,1minutos (90-180). Tiempo medio de isquemia caliente 19,2minutos (10-30). Pérdida sanguínea media: 97ml (50-300). Se realizaron puntos hemostáticos individuales antes de la aplicación del sellador de fibrina, en caso de sangrado activo importante (14 casos). No se registró ningún caso de sangrado ni fallo renal en el postoperatorio. Un paciente requirió transfusión sanguínea debido a gran hematoma en pared abdominal. El 65% fue carcinoma de célula clara renal, el 10% carcinoma papilar y un 20% fueron oncocitomas. La tasa de márgenes negativos fue del 100%. El tiempo medio de ingreso hospitalario fue 4 días (2-6). El seguimiento medio fue de 14 meses (5-45).

Conclusiones

Excluir la renorrafia durante la nefrectomía parcial laparoscópica es posible y seguro. Nuestra experiencia inicial con este sellador de fibrina ha sido positiva, aunque probablemente se necesiten más casos y seguimiento para determinar el beneficio de esta técnica quirúrgica.

Palabras clave:
Nefrectomía parcial laparoscópica
Fibrina autóloga (sistema Vivostat®)
Hemostasia

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