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Eliminating knot tying during warm ischemia time for laparoscopic partial nephrectomy.
Marcelo A Orvieto1, Gary W Chien, Brett Laven
1Section of Urology, University of Chicago, Chicago, Illinois 60637, USA.
The Journal of Urology
|November 13, 2004
Summary
This study introduces a novel technique for laparoscopic partial nephrectomy (LPN) that eliminates knot tying using absorbable clips. This method simplifies the procedure and reduces warm ischemia time (WIT), proving safe and efficient for renal tumor removal.
Area of Science:
- Urology
- Minimally Invasive Surgery
- Surgical Oncology
Background:
- Laparoscopic partial nephrectomy (LPN) presents challenges in intracorporeal suturing.
- Knot tying during the warm ischemia time (WIT) is a significant time-consuming factor in LPN procedures.
Purpose of the Study:
- To present a technique for LPN that eliminates the need for knot tying.
- To evaluate the outcomes of this novel suturing method in a series of patients.
Main Methods:
- A technique using absorbable clips (LapraTy) to secure sutures without knot tying was employed in 32 patients undergoing LPN for T1a renal tumors.
- Suturing of the collecting system and parenchyma was performed using polyglactin sutures secured with clips, obviating traditional knot tying.
- Watertightness was confirmed using methylene blue solution post-suturing.
Main Results:
- The mean operative time was 224.2 minutes, with a mean WIT of 33.1 minutes.
- The collecting system was entered in 65.6% of cases, requiring closure with the described technique.
- No postoperative bleeding or urine leaks were observed in the series.
Conclusions:
- The use of LapraTy clips offers a safe and efficient alternative to knot tying in LPN.
- This technique simplifies the surgical procedure and enables completion of suturing within an acceptable WIT.
- The method facilitates efficient closure of the collecting system and parenchyma during LPN.