scholarly journals Sutureless laparoscopic partial nephrectomy using fibrin gel reduces ischemia time while preserving renal function

2019 ◽  
Vol 91 (1) ◽  
pp. 30-34 ◽  
Author(s):  
Daniele Tiscione ◽  
Tommaso Cai ◽  
Lorenzo Giuseppe Luciani ◽  
Marco Puglisi ◽  
Daniele Mattevi ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Kidney Function ◽  
Charlson Comorbidity Index ◽  
Operative Time ◽  
Warm Ischemia ◽  
Control Group ◽  
Fibrin Gel ◽  
Ischemia Time ◽  
Comorbidity Index

Objectives: We evaluated the efficacy of sutureless laparoscopic partial nephrectomy (LPN), using a fibrin gel in order to minimize renal ischemia time and preserve kidney function. Materials and Methods: Nineteen patients (mean age 58.3 ± 7.1) undergoing sutureless LPN using a fbrin gel were compared with a control group consisting of 21 patients (mean age 57.9 ± 7.5) subjected to LPN with standard suturing. Intraand post-operative data for the two groups were compared. The following parameters were recorded: patient demographics, Charlson Comorbidity Index, tumor characteristics according to the RENAL score, warm ischemia and operative times, estimated blood loss, mean hospital stay, post-operative complications referring to the Clavien-Dindo classification, renal function parameters pathologic and follow-up data. The main outcome measure was renal ischemia time and maintenance of kidney function. Results: Median warm ischemia time was 13 minutes (range 11-19) in the group treated with fibrin gel and 19 (range 17- 29) in the control group, with a statistically significant difference (p < 0.001). The two groups were homogeneous in terms of the Charlson Comorbidity Index (4.6 vs 4.8) and RENAL score (9.6 vs 9.4). Median operative time differed significantly in the two groups, 183 minutes (range 145-218) in the group treated with fibrin gel and 201 (range 197-231) in the control group (p < 0.001). A negative surgical margin was reported in 18 patients (94.7%) in the group treated with fibrin gel and in 21 patients (100%) in the control group. No difference in renal function was found between the two groups. Conclusions: Sutureless LPN with fibrin gel can reduce warm ischemia and total operative time while preserving kidney function.

Use of comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys to investigate the role of nonmodifiable factors in determining ultimate renal function.

2011 ◽  
Vol 29 (7_suppl) ◽  
pp. 321-321
Author(s):  
B. R. Lane ◽  
P. Russo ◽  
R. Uzzo ◽  
A. V. Hernandez ◽  
S. A. Boorjian ◽  
...  
Keyword(s):  
Renal Function ◽  
Partial Nephrectomy ◽  
Statistical Significance ◽  
Warm Ischemia ◽  
Ischemia Time ◽  
Solitary Functioning Kidney ◽  
Modifiable Factors ◽  
Multivariable Analyses ◽  
The Impact ◽  
Functioning Kidney

321 Background: Factors that determine renal function after partial nephrectomy (PN) are not well defined, including the impact of cold vs. warm ischemia and the relative importance of modifiable and non-modifiable factors. We studied these determinants in a large cohort of patients with a solitary functioning kidney undergoing PN. Methods: In 1980–2009, 660 PN were performed at 4 centers for tumor in a solitary-functioning kidney under cold (n=300) or warm (n=360) ischemia. Data were collected in IRB-approved registries; follow- up averaged 4.5 years. Pre- and postoperative glomerular filtration rates (GFR) were estimated via CKD-EPI equation. Results: At 3 months after PN, median GFR decreased by equivalent amounts with cold or warm ischemia (21% vs. 22%, respectively, p=0.7) although median cold ischemic times were much longer (45 vs. 22 min. respectively, p<0.001). In multivariable analyses, increasing age, larger tumor size, lower preoperative GFR, and longer ischemia time were associated with decreased postoperative GFR (p<0.05). When percentage of parenchyma spared was incorporated into the analysis, this factor and preoperative GFR proved to be the primary determinants of ultimate renal function, and duration of ischemia lost statistical significance. Conclusions: This non-randomized comparative study suggests that long-term renal function after PN is determined primarily by the quantity and quality of renal parenchyma that can be preserved. Within the relatively strict parameters of conventional practice, i.e. predominantly short ischemic intervals and liberal use of hypothermia, ischemia time was not an independent predictor of ultimate renal function after PN. Nevertheless, type and duration of ischemia remain the most important modifiable factors during PN, and mandate further study. [Table: see text]

scholarly journals Predictors of surgical outcomes of retroperitoneal laparoscopic partial nephrectomy

2020 ◽  
Vol 92 (3) ◽  
Author(s):  
Carmine Sciorio ◽  
Pier Paolo Prontera ◽  
Salvatore Scuzzarella ◽  
Paolo Verze ◽  
Lorenzo Spirito ◽  
...  
Keyword(s):  
Blood Loss ◽  
Partial Nephrectomy ◽  
Surgical Outcomes ◽  
Operative Time ◽  
Statistical Significance ◽  
Tumour Size ◽  
Warm Ischemia ◽  
Warm Ischemia Time ◽  
Ischemia Time ◽  
Length Of Hospitalization

Objectives: To evaluate surgical outcomes in a series of laparoscopic retroperitoneal partial nephrectomies.Methods: A total of 147 patients who underwent laparoscopic retroperitoneal partial nephrectomy by a single surgeon were evaluated. Pre-operative parameters (body mass index, ASA score, tumour size, cTNM stage, PADUA score risk, surgeon experience) and intraoperative and postoperative outcomes (operative mean time, warm ischemia time, blood loss, transfusion rate, length of hospitalization, and margin-ischaemiacomplications [MIC] success rate) were considered. Results: For 134 patients (91.1%) the success of the treatment, defined by a MIC = 3, was obtained. When the statistical significance of each of the independent variables was tested, surgeon’s experience added statistical significance to the prediction of operative time (p = 0.000), warm ischemia time (p = 0.000) and blood loss (p = 0.000); tumour size (p = 0.046) to the prediction MIC (p = 0.010), operative time (p = 0.000), warm ischemia time (p = 0.003) and blood loss (p = 0.010); ASA score to the length of hospitalization (p = 0.009). Conclusions: Laparoscopic retroperitoneal partial nephrectomy represents an adequate and safe technique for the treatment of T1 renal cancer. Optimal MIC success rate can be achieved, although intraoperative outcomes tend to be related to the learning curve even in a very experienced laparoscopic surgeon. Length of hospitalization depends on general health condition of patients.

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