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Application of Hemostatic Devices in Laparoscopic Hepatectomy
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Simplified hemostatic technique during laparoscopic partial nephrectomy.

Alexander Tsivian1, Matvey Tsivian, Shalva Benjamin

  • 1Department of Urologic Surgery, The E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. atsivian@hotmail.com

International Braz J Urol : Official Journal of the Brazilian Society of Urology
|March 9, 2012
PubMed
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This study presents a simplified suture technique for laparoscopic partial nephrectomy (LPN) defect closure. The method achieves effective hemostasis without additional agents, proving reliable and quick for surgeons.

Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Surgical Techniques

Background:

  • Laparoscopic partial nephrectomy (LPN) is increasingly popular but technically demanding.
  • Renal defect closure is a critical step for hemostasis and preventing complications.
  • This study details a suture-only technique for renal defect closure during LPN.

Purpose of the Study:

  • To describe and evaluate a simplified technique for renal defect closure during LPN using sutures exclusively for hemostasis.
  • To assess the feasibility, safety, and efficacy of this suture-based approach.

Main Methods:

  • Transperitoneal approach for kidney access.
  • Renal artery clamping and tumor excision.
  • Two-layer, knot-free continuous suture closure of the renal defect, including the collecting system if opened.

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  • Absorbable clips used on one parenchymal edge for the superficial layer.
  • Exclusion of bolsters, glues, or other hemostatic agents.

    • Main Results:

    • Technique applied in 34 patients with tumor sizes ranging from 17-85 mm.
    • Median warm ischemia time: 23 minutes (range 12-45 min).
    • Median estimated blood loss: 55 mL (range 30-1000 mL).
    • No intraoperative complications, conversions to open surgery, urine leaks, or postoperative bleeding observed.

    Conclusions:

    • The simplified suture technique is reliable and rapid for LPN defect closure.
    • This approach offers potential economic advantages by avoiding routine use of additional hemostatic agents.
    • The technique provides satisfactory surgical outcomes without compromising patient safety.