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Feasibility of laparoscopic partial nephrectomy using pledgeted compression sutures for hemostasis.
David M Wilhelm1, Kenneth Ogan, M H Saboorian
1Clinical Center for Minimally Invasive Urologic Cancer Treatment, Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Journal of Endourology
|June 21, 2003
Summary
This study explored a new laparoscopic partial nephrectomy (LPN) technique without hilar clamping in pigs. While it allows large kidney resections, further refinements are needed for better bleeding control in clinical use.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Renal Surgery
Background:
- Laparoscopic partial nephrectomy (LPN) is a standard procedure for kidney tumors.
- Achieving hemostasis and managing large resections without hilar occlusion remain challenges.
Purpose of the Study:
- To develop and evaluate a novel LPN technique using pledgeted parenchymal compression sutures without hilar occlusion.
- To assess the feasibility of large renal segment resection and hemostasis in a porcine model.
Main Methods:
- Laparoscopic transperitoneal partial nephrectomy was performed on five pigs.
- Pledgeted sutures were used intracorporeally to induce regional renal hypoperfusion.
- Renal function was monitored postoperatively, and specimens were analyzed after 2 weeks.
Main Results:
- The technique allowed resection of an average of 35% of the kidney.
- Median operative time was 154.5 minutes, with median blood loss of 137.5 mL.
- Adjunctive hemostatic clips were necessary for central vessel bleeding; no urinary extravasation occurred.
Conclusions:
- Pledgeted sutures enable large renal segment resection in LPN without hilar occlusion in a porcine model.
- Technical improvements are needed to enhance hemostasis for broader clinical application.
- Current limitations restrict this technique to small, exophytic tumors.