Feasibility of felt application for renorrhaphy after laparoscopic partial nephrectomy

Laparoscopic partial nephrectomy (LPN) has become a well-established treatment for selected renal malignancies. Aim of the study was to explore feasibility of the application of haemostatic felt pledgets during renorrhaphy after Laparoscopic Partial Nephrectomy (LPN) and evaluate its efficacy.

Between May 2008 and December 2011, 42 patients underwent LPN as a treatment for renal tumors by a single surgeon. Tumor size and location were assessed by contrast enhanced computed tomography (CT) scan. A rolled Tabotamp was placed on the tumor bed; 2/0 Vycril sutures, secured with 5mm Hem-o-lok clips, were used to perform the renorrhaphy. 7.9x7.9 mm (5/16"x5/16") felt pledgets were placed between the hem-o-lok clips and the renal parenchyma on both needle entrance sites. W.i.t., EBL, OR time, post-operative complications and hospital stay were recorded.

Mean w.i.t. was 21±5 min, mean OR time 151±52 min, while EBL was 162±56 cc. Surgical complications were recorded in 11/42 (26%; Clavien-Dindo classification: II-III). Three patients experienced postoperative ileus, 3 had a urinary leakage, 1 a wound infection and 4 tumor bed bleeding: of these, 2 required blood transfusions, 1 was managed by embolization and 1 underwent nephrectomy. Mean LOS was 2 days.

The application of hemostatic felt pledgets during renorrhaphy after LPN is feasible and safe. This technique may reduce cortical bleeding, and could ameliorate surgical outcomes.