scholarly journals A comparison of renal functional outcomes after partial nephrectomy with and without pedicle clamping

2021 ◽  
Vol 9 (1) ◽  
pp. 16-16
Author(s):  
Amin Bagheri ◽  
Kamaleddin Hasanzadeh Nokashti ◽  
Alireza Farshi ◽  
Morteza Ghojazadeh
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Functional Outcomes ◽  
Analytical Study ◽  
Operative Blood Loss ◽  
Renal Function Decline ◽  
Duration Of Surgery ◽  
Short Run ◽  
The Mean

Introduction: Considering the mixed results reported about partial nephrectomy with and without pedicle clamping, this study aimed to compare the impacts of these two techniques on renal functional outcome. Materials and methods: this descriptive analytical study was conducted on 40 patients with renal cancer who underwent partial nephrectomy. They were randomly assigned to pedicle clamping (20 patients) and non-clamping groups(20 patients). The day before surgery, the routine tests as well as DTPA scan were carried out and some questions were asked from them; during the surgery, the amount of blood loss and the duration of pedicle clamping were measured; and after the surgery, the needed tests were performed for all of the patients. Also, 3 months after being discharged from the hospital, DTPA scan was carried out for all of the patients once again. Finally, the obtained data were all fed into SPSS v18 and the needed statistical analyses were performed. Results: The levels of operative blood loss(P=0.000) and blood transfusion(P=0.001) in non-pedicle clamping group were higher than other group. The mean duration of surgery in the clamping group was 139.2 minutes and non-pedicle group 149 minutes (P=0.258). The results of renal scans 3 months after the surgery indicated that the level of renal function decline in the pedicle clamping group was significantly higher than that in the non-pedicle clamping group(P=0.000). Conclusion: The results of this study indicated that partial nephrectomy without pedicle clamping can lead to a better renal function in the short run.

scholarly journals Polyethylene glycol-coated collagen patch (hemopatch®) in open partial nephrectomy

2021 ◽  
Author(s):  
Michael Staehler ◽  
S. Rodler ◽  
M. Schott ◽  
J. Casuscelli ◽  
C. Stief ◽  
...  
Keyword(s):  
Renal Function ◽  
Polyethylene Glycol ◽  
Blood Loss ◽  
Partial Nephrectomy ◽  
Low Complexity ◽  
High Complexity ◽  
Open Partial Nephrectomy ◽  
Duration Of Surgery ◽  
Coated Collagen

Abstract Purpose To describe the results of a polyethylene glycol-coated collagen patch, Hemopatch® on blood loss, surgical time and renal function in partial nephrectomy (PN) for renal cell carcinoma (RCC). Methods Out of a single surgeon cohort of n = 565 patients undergoing conventional open PN (CPN) between 01/2015 and 12/2017 at the University of Munich a consecutive subgroup (n = 42) was operated on using a polyethylene glycol-coated collagen-based sealant Hemopatch® (Baxter International Inc., Deerfield, IL, USA) (HPN). Results Median age was 65.2 years (range 12.7–95.2) with median follow-up of 9.43 months (0.03–49.15). Baseline renal function (CKD-EPI) was 78.56 ml/min/1.73 m2 (range 20.38–143.09) with a non-significant decline to 74.78 ml/min/1.73 m2 (range 3.75–167.74) at follow-up. In CPN 46% had low complexity, 33% moderate complexity and 20% high complexity lesions with 33% low, 40% moderate and 27% high complexity masses in HPN. Median tumor size was 4.3 cm (range 1–38 cm) in CPN with 4.8 cm (range 3.8–18.3 cm) with HPN, p = 0.293. Median blood loss and duration of surgery was significantly lower in the HPN group vs. CPN (146 ml ± 195 vs. 114 ml ± 159 ml; p = 0.021; 43 min ± 27 for HPN vs. 53 min ± 49; p = 0.035) with no difference in clamping time (12.6 min ± 8.6 for HPN vs. 12.0 min ± 9.5; p = 0.701). Conclusions Hemopatch® supported renoraphy shows promising results compared to standard renoraphy in PN. No side effects were seen. Further studies should evaluate the prevention of arterio-venous or urinary fistulas. In complex partial nephrectomies Hemopatch® supported renoraphy should be considered.

scholarly journals Open Partial Nephrectomy with Zero Ischaemia Using a Supra 12th Rib Miniflank Incision: A Minimally Invasive Open Approach for Small Renal Masses

2021 ◽  
Vol 2021 ◽  
pp. 1-5
Author(s):  
Syed Ali Ehsanullah ◽  
Abida Sultana ◽  
Brian Kelly ◽  
Charlotte Dunford ◽  
Zaheer Shah
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Minimally Invasive ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Tumour Size ◽  
Open Approach ◽  
Open Partial Nephrectomy ◽  
Estimated Blood Loss ◽  
The Mean

Introduction. To assess a minimally invasive open technique for partial nephrectomy with zero ischaemia time. Methods. A review was performed in a prospectively maintained database of a single surgeon series of all patients undergoing partial nephrectomy using a supra 12th rib miniflank incision with zero ischaemia. Data of seventy one patients who underwent a partial nephrectomy over an 82-month period were analyzed. Data analyzed included operative time, estimated blood loss, pre and postoperative renal function, complications, final pathological characteristics, and tumour size. Results. Seventy one partial nephrectomies were performed from February 2009 to October 2015. None were converted to radical nephrectomy. Mean operative time was 72 minutes (range 30–250), and mean estimated blood loss was 608 mls (range 100–2500) with one patient receiving blood transfusion. The mean pre and postoperative haemoglobin levels were 144 and 112 g/l. The mean pre and postoperative creatinine levels were 82 and 103 Umol/L. There were 8 Clavian–Dindo Grade 2 complications and 1 major complication (Clavian IIIa). Histology confirmed 24 benign lesions and 47 malignant lesions, 46 cT1a lesions, 24 cT1b lesions, and 1 cT2 lesion. Median follow-up was 38 months with no local recurrence or progression of disease with 5 patients having a positive margin (7%). Conclusion. Our results demonstrate that a supra 12th miniflank incision open partial nephrectomy with zero ischaemic time for SRMs has satisfactory outcomes with preservation of renal function. A minimally invasive open partial nephrectomy remains an important option for units that cannot offer patients a laparoscopic or a robotic procedure.

scholarly journals Nonstructural bone graft for single-segment lumbar tuberculosis: surgical indications, clinical efficacy, and preliminary experiences in 34 patients

2021 ◽  
Vol 49 (1) ◽  
pp. 030006052098278
Author(s):  
Xing Du ◽  
Yunsheng Ou ◽  
Guanyin Jiang ◽  
Yong Zhu ◽  
Wei Luo ◽  
...  
Keyword(s):  
Blood Loss ◽  
Hospital Stay ◽  
Bone Graft ◽  
Cobb Angle ◽  
Clinical Efficacy ◽  
Operative Time ◽  
Bone Grafts ◽  
Surgical Indications ◽  
Operative Blood Loss ◽  
The Mean

Objective This study was performed to evaluate the surgical indications, clinical efficacy, and preliminary experiences of nonstructural bone grafts for lumbar tuberculosis (TB). Methods Thirty-four patients with lumbar TB who were treated with nonstructural bone grafts were retrospectively assessed. The operative time, operative blood loss, hospital stay, bone graft fusion time, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) concentration, visual analog scale (VAS) score, Oswestry Disability Index (ODI), American Spinal Injury Association (ASIA) impairment grade, and Cobb angle were recorded and analyzed. Results The mean operative time, operative blood loss, hospital stay, Cobb angle correction, and Cobb angle loss were 192.59 ± 42.16 minutes, 385.29 ± 251.82 mL, 14.91 ± 5.06 days, 9.02° ± 3.16°, and 5.54° ± 1.09°, respectively. During the mean follow-up of 27.53 ± 8.90 months, significant improvements were observed in the ESR, CRP concentration, VAS score, ODI, and ASIA grade. The mean bone graft fusion time was 5.15 ± 1.13 months. Three complications occurred, and all were cured after active treatment. Conclusions Nonstructural bone grafts may achieve satisfactory clinical efficacy for appropriately selected patients with lumbar TB.

scholarly journals A clinico-surgical outcome of vaginal hysterectomy with or without hydro dissection: a Quasi experimental study

2018 ◽  
Vol 7 (9) ◽  
pp. 3668
Author(s):  
Kirti M. Hurakadli ◽  
L. L. Pujari ◽  
Prashant G.
Keyword(s):  
Blood Loss ◽  
Vaginal Hysterectomy ◽  
Minimal Invasive Surgery ◽  
Minimal Invasive ◽  
Intraoperative Blood Loss ◽  
Duration Of Surgery ◽  
Quasi Experimental ◽  
Abdominal Route ◽  
The Mean ◽  
Lower Morbidity

Background: Vaginal hysterectomy -the signature operation of gynecologic profession, is a hallmark of gynecological extirpative hysterectomy surgery and surgical excellance1. In the era of minimal invasive surgery, Nondescent vaginal hysterectomy has evolved over the years and is opted over abdominal route. It is because of lower morbidity, less postoperative pain, more rapid   return to normal activities and lesser hospital stay associated with this route of surgery. Practice of hydrodissection with diluted adrenalin has been noticed by few surgeons.Methods: We did a retrospective analysis of 267 cases of vaginal hysterectomies in our hospital over a period of three years, regarding the benefit of hydro dissection in reducing the blood loss and time of surgery, so as to incorporate this technique on routine basis.Results: Of 267 cases, NDVH was done in 107 (40.1%) cases, and 160 (59.9%) patients underwent vaginal hysterectomy with PFR. Of 267 cases, 121 (45.3%) cases had hydro dissection. In 146 (54.7%) cases hydro dissection was not done. The mean blood loss was significantly reduced in cases with hydro dissection to a mean of 1.07 mops when compared to cases with no hydro dissection-mean of 1.71 mops. Duration of surgery was also significantly reduced to a mean of 39.9 minutes in cases with hydro dissection when compared to cases with no hydro dissection with a mean of 46.3 minutes. There was no significant change in duration of hospital stay.Conclusions: Hydro dissection with diluted adrenaline should be routinely practice by all vaginal surgeons to reduce the duration of surgery and intraoperative blood loss.

scholarly journals Associations between radiographic characteristics and change in renal function following partial nephrectomy using 24-hour creatinine clearance

2013 ◽  
Vol 5 (1) ◽  
pp. 45
Author(s):  
Rodney H. Breau ◽  
Aaron T.D. Clark ◽  
Chris Morash ◽  
Dean Fergusson ◽  
Ilias Cagiannos
Keyword(s):  
Renal Function ◽  
Creatinine Clearance ◽  
Partial Nephrectomy ◽  
Tumour Size ◽  
Multivariable Analysis ◽  
Function Change ◽  
Tumour Location ◽  
Function Preservation ◽  
The Mean ◽  
The Impact

Background: Radiographic characteristics may be associated withthe degree of renal function preservation following partial nephrectomy.The purpose of this study was to determine the impact ofpreoperative radiographic variables on change in renal functionusing 24-hour urine creatinine clearance (uCrCl).Methods: Patients with partial nephrectomy performed fromNovember 2003 to 2008 were enrolled in the study. Serum creatinineand 24-hour urine was collected preoperatively and at3, 6 and 12 months postoperatively. Computed tomography ormagnetic resonance imaging was used to determine tumour size,tumour location and renal volume.Results: Of the 36 patients, median age was 62 (range 30-78) and21 (58%) were male. The mean tumour diameter was 2.8±1.4 cm.Twenty-two (61%) tumours were located at the renal pole and11 (31%) were endophytic. Overall, mean preoperative uCrClwas 88.8±34.2 mL/min and mean postoperative uCrCl was82.8±33.6 mL/min (6.8%; p < 0.01). On multivariable analysis,no single characteristic was associated with a clinically prohibitivedecrease in renal function (-9.4% if endophitic, p = 0.06; -0.57%per cm diameter, p = 0.73; and -6.9% if located at the renal pole,p = 0.15). The total renal volume was also not significantly associatedwith renal function change (-1.1% per 100 cc, p = 0.86).Interpretation: Preoperative radiographic characteristics seem tobe associated with small changes in renal function following partialnephrectomy. These data support renal functional benefits of partialnephrectomy regardless of tumour size and location.

scholarly journals Peripartum hysterectomy for cesarean section with morbidly adherent placenta: case series of 25 patients

2018 ◽  
Vol 7 (10) ◽  
pp. 3980
Author(s):  
Abdulrahman M. Rageh ◽  
Mohamed Khalaf ◽  
Ahmed M. Abbas ◽  
Hossam T. Salem
Keyword(s):  
Blood Loss ◽  
Placenta Accreta ◽  
Placenta Previa ◽  
Case Series ◽  
Bladder Injury ◽  
Operative Blood Loss ◽  
Ureteric Injury ◽  
Total Blood ◽  
Peripartum Hysterectomy ◽  
The Mean

Background: The current paper reports the outcome of case series of patients presented with placenta accreta confirmed histopathologicaly after management by peripartum hysterectomy.Methods: The study was set in Women’s Health Hospital, Assiut University, Egypt. This was a case series of 25 women presented with placenta accreta between May 2017 and April 2018. We included all pregnant women with placenta previa as diagnosed by ultrasound with suspicion of abnormal placentation by Doppler, confirmed intra-operatively undergoing either emergent or elective CS. All cases were performed by an expert team of obstetricians and anesthetists. Cesarean delivery was done under general anesthesia through pfannensteil incision. The primary outcome was the estimated intra-operative blood loss through assessment of amount of blood in the suction by ml, difference between the weight of surgical drapes and towels before and after operation.Results: Pre-operative Hb was 10.64±1.01 gm/dL and there was significant decline in the postoperative Hb reaching 8.36±1.21 gm/dL (p<0.001). The mean drop in Hb was 2.28±1.43gm/dL. Estimated intra-operative blood loss was 974.4±398.05 ml in the towels and 847.6±362.56 ml in the suction apparatus. The total blood loss was 1822±653.73 ml. The mean number of units of whole blood transfused was 2160.0±825.6 ml and fresh frozen plasma was 1010.0±349.7 ml. Regarding intra-operative complications, bladder injury was the most common one in 14 cases (56%), followed by ureteric injury in two cases (8%). Postoperative ICU admission was in 6 cases (24%) and the mean duration of hospital stay 12.44 ± 4.07 days. No cases of maternal mortality.Conclusions: In conclusion, peripartum hysterectomy is considered life-saving surgery in patients with placenta accreta.

Uterine Isthmus Tourniquet during Abdominal Myomectomy: Support or Hazard? A Randomized Double-Blind Trial

2020 ◽  
Vol 85 (5) ◽  
pp. 396-404
Author(s):  
Abolfazl Mehdizadehkashi ◽  
Kobra Tahermanesh ◽  
Samaneh Rokhgireh ◽  
Vahideh Astaraei ◽  
Zahra Najmi ◽  
...  
Keyword(s):  
Blood Loss ◽  
Ovarian Reserve ◽  
Operating Time ◽  
Serum Levels ◽  
Massive Hemorrhage ◽  
Control Group ◽  
Double Blind ◽  
Abdominal Myomectomy ◽  
Duration Of Surgery ◽  
The Mean

<b><i>Background and Objectives:</i></b> A tourniquet has been suggested as a useful means of reducing massive hemorrhage during myomectomy. However, it is not clear whether the restricted perfusion affects the ovaries. In the present study, we examined the effect of a tourniquet on ovarian reserve and blood loss during myomectomy. <b><i>Materials and Methods:</i></b> In a randomized double-blind clinical trial, fertile nonobese patients scheduled for abdominal myomectomy at Rasool-e-Akram Hospital from February 2018 to June 2019 were randomized to a tourniquet (<i>n</i> = 46) or a non-tourniquet group (<i>n</i> = 35). Serum levels of anti-Müllerian hormone (AMH) and follicle-stimulating hormone (FSH) were measured before and 3 months after surgery, blood loss was recorded during surgery, and serum levels of hemoglobin (Hb) were recorded before surgery, 6 h and 3 days after surgery. SPSS version 21 was used for statistical analysis. <b><i>Results:</i></b> Demographic, obstetric, and myoma characteristics were similar in the 2 groups (<i>p</i> &#x3e; 0.05). The mean baseline values of AMH and FSH did not differ between groups (<i>p</i> &#x3e; 0.05). After surgery, only FSH was higher in the control group (<i>p</i> = 0.043). Despite the time taken to fasten and open the tourniquet, the mean operating time was shorter in the tourniquet group (<i>p</i> &#x3c; 0.001). Blood loss was higher in the control group (<i>p</i> = 0.005). The drop in Hb levels at 6 h after surgery was higher in the non-tourniquet group (<i>p</i> = 0.002). Blood loss was significantly associated with the duration of surgery (<i>r</i> = 0.523, <i>p</i> &#x3c; 0.001). <b><i>Conclusion:</i></b> The use of a tourniquet during abdominal myomectomy significantly reduced the mean volume of blood loss compared to the non-tourniquet group, while it did not prolong the duration of surgery, nor reduced the ovarian reserve. A tourniquet is a safe and efficient measure during abdominal myomectomy.

The Self-Retaining Barbed Suture for Parenchymal Repair in Laparoscopic Partial Nephrectomy: A Systematic Review and Meta-Analysis

2019 ◽  
Vol 26 (6) ◽  
pp. 744-752
Author(s):  
Hailun Zhan ◽  
Chunping Huang ◽  
Tengcheng Li ◽  
Fei Yang ◽  
Jiarong Cai ◽  
...  
Keyword(s):  
Renal Function ◽  
Blood Loss ◽  
Hospital Stay ◽  
Partial Nephrectomy ◽  
Operative Time ◽  
Meta Analysis ◽  
Length Of Hospital Stay ◽  
The Self ◽  
Barbed Suture ◽  
Estimated Blood Loss

Objectives. The warm ischemia time (WIT) is key to successful laparoscopic partial nephrectomy (LPN). The aim of this study was to perform a meta-analysis comparing the self-retaining barbed suture (SRBS) with a non-SRBS for parenchymal repair during LPN. Methods. A systematic search of PubMed, Scopus, and the Cochrane Library was performed up to March 2018. Inclusion criteria for this study were randomized controlled trials (RCTs) and observational comparative studies assessing the SRBS and non-SRBS for parenchymal repair during LPN. Outcomes of interest included WIT, complications, overall operative time, estimated blood loss, length of hospital stay, and change of renal function. Results. One RCT and 7 retrospective studies were identified, which included a total of 461 cases. Compared with the non-SRBS, use of the SRBS for parenchymal repair during LPN was associated with shorter WIT ( P < .00001), shorter overall operative time ( P < .00001), lower estimated blood loss ( P = .02), and better renal function preservation ( P = .001). There was no significant difference between the SRBS and non-SRBS with regard to complications ( P = .08) and length of hospital stay ( P = .25). Conclusions. The SRBS for parenchymal repair during LPN can significantly shorten the WIT and overall operative time, decrease blood loss, and preserve renal function.

scholarly journals Local infiltration of analgesia and tranexamic acid is safe and efficacious in reducing blood loss and comparable to intra-articular tranexamic acid in total knee replacements

2021 ◽  
Author(s):  
H Sivasubramanian ◽  
CMP Tan ◽  
L Wang
Keyword(s):  
Pain Relief ◽  
Blood Loss ◽  
Total Knee Replacement ◽  
Tranexamic Acid ◽  
Knee Replacement ◽  
Functional Outcomes ◽  
Primary Total Knee Replacement ◽  
Total Knee ◽  
The Mean ◽  
Primary Total Knee

Introduction: The use of peri-articular (PA) tranexamic acid (TXA) and its efficacy in comparison with intra-articular (IA) tranexamic acid has not been well explored in literature. This retrospective cohort study aims to compare the effects of IA and PA TXA with analgesic components in reducing blood loss and improving immediate post-operative pain relief and functional outcomes in unilateral primary total knee replacement (TKA) patients. Methods: 63 patients who underwent a unilateral primary total knee replacement procedure were divided into 2 groups: 42 patients in the IA TXA delivery group, 21 patients in the PA TXA group. 1g of TXA was utilized for all patients. All patients had pericapsular infiltration consisting of 0.5ml of Adrenaline, 0.4ml of Morphine, 1g of Vancomycin, 1ml of Ketorolac and 15ml of Ropivacaine. Outcomes for blood loss, and surrogate markers for immediate functional recovery were measured. Results: 54.0% of the patients were female, 46.0% male. The mean drop in post-operative Hb levels in the PA and IA group was 2.0g/dL and 1.6 g/dL respectively, and statistically insignificant (p=0.10). The mean HCT drop in the PA and IA group was 6.1% and 5.3% respectively and statistically insignificant (p=0.58). The POD 1 and discharge day flexion angles, POD 1 and POD 2 VAS scores, gait distance on discharge, and length of hospitalization stay were largely similar in both groups. Conclusion: Our study shows that both IA and PA TXA with analgesic components are equally efficient in reducing blood loss and improving immediate postoperative pain relief and functional outcomes.

scholarly journals A Comparative Study of Conventional versus Endoscopic Septoplasty

2018 ◽  
Vol 26 (1) ◽  
pp. 1-9
Author(s):  
Ankita Singh ◽  
Nalini Bhat ◽  
Pallavi Bhandarkar ◽  
Ram Singh
Keyword(s):  
Blood Loss ◽  
Conventional Method ◽  
Clinical Results ◽  
Symptomatic Improvement ◽  
Operative Blood Loss ◽  
Endoscopic Septoplasty ◽  
Endoscopic Method ◽  
Post Operative Pain ◽  
Septal Surgery ◽  
Duration Of Surgery

Introduction The standard surgical treatment for symptomatic deviated septum is septoplasty. This is usually done conventionally using the headlight. However, in recent years the endoscopic method has emerged as an alternative technique. This study aims to compare results of conventional and endoscopic septoplasty Materials and Methods A study comprising of 44 patients, randomly divided in two groups, was undertaken to compare the efficacy of both the techniques. This study evaluated parameters like postoperative subjective improvement in symptoms, using the NOSE questionnaire, intra-operative blood loss, duration of surgery, post-operative pain and complications across the two groups. Further, cases were subgrouped according to the site of deviation as anterior, posterior or combined and the efficacy of these two methods for correcting different sites of deviation was assessed, using the same parameters. Results The endoscopic approach showed better overall clinical results, irrespective of the site of deviation. It was noted that correcting posterior deviations required shorter time and had lesser blood loss when operated using the endoscope whereas anterior deviations were dealt faster and had lesser bleeding by the conventional method. There was less pain and morbidity in the postoperative period in the endoscopic group as compared to conventional group. Discussion Historical perspective of the conventional and endoscopic septal surgery is mentioned. In review of literature on the four parameters of this study – Symptomatic improvement, intra-operative blood loss, post-operative pain and surgical complications, were compared with published reports. Conclusion Endoscopic septoplasty was found to have distinct advantages over the conventional method, more so for posterior septal deviations. It should be an option offered to all patients requiring septoplasty.

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