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Renal function tests are crucial for assessing kidney health, monitoring disease progression, and evaluating the kidneys' efficiency in waste elimination, fluid balance, and electrolyte regulation. These tests offer critical insights into kidney function, even though routine measurements may appear normal until there is a significant decline in the glomerular filtration rate or GFR. Typically, signs of kidney impairment only become evident when the GFR falls to about 50% of its normal level.
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In a three-phase circuit, line loss is an indicator of energy dissipated as heat due to the resistance of transmission lines. To address this, incorporating transformers into the system—a step-up transformer at the source and a step-down transformer at the load—is a strategic solution. Two three-phase transformers are introduced to improve this.
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Sutureless laparoscopic partial nephrectomy using fibrin gel reduces ischemia time while preserving renal function.

Daniele Tiscione1, Tommaso Cai, Lorenzo Giuseppe Luciani

  • 1Department of Urology, Santa Chiara Regional Hospital, Trento. daniele.tiscione@apss.tn.it.

Archivio Italiano Di Urologia, Andrologia : Organo Ufficiale [Di] Societa Italiana Di Ecografia Urologica E Nefrologica
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Summary

Sutureless laparoscopic partial nephrectomy using fibrin gel significantly reduces renal ischemia and operative times. This technique effectively preserves kidney function compared to standard suturing methods.

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Area of Science:

  • Urology
  • Minimally Invasive Surgery
  • Nephrology

Background:

  • Partial nephrectomy is crucial for kidney preservation.
  • Minimizing renal ischemia time is vital for maintaining kidney function.
  • Sutureless techniques aim to improve surgical efficiency and outcomes.

Purpose of the Study:

  • To evaluate the efficacy of sutureless laparoscopic partial nephrectomy (LPN) using fibrin gel.
  • To assess the impact of fibrin gel on renal ischemia time and kidney function.
  • To compare sutureless LPN with fibrin gel against standard sutured LPN.

Main Methods:

  • A comparative study involving 19 patients undergoing sutureless LPN with fibrin gel and 21 patients undergoing standard LPN.
  • Key parameters recorded include warm ischemia time, operative time, blood loss, complications, and renal function.
  • Patients were stratified by Charlson Comorbidity Index and RENAL score.

Main Results:

  • Sutureless LPN with fibrin gel demonstrated significantly shorter median warm ischemia time (13 vs. 19 minutes) and operative time (183 vs. 201 minutes).
  • Both groups showed comparable patient demographics, comorbidity indices, and tumor complexity (RENAL score).
  • Negative surgical margins were achieved in 94.7% of the fibrin gel group and 100% of the control group, with no significant difference in renal function post-operatively.

Conclusions:

  • Sutureless LPN employing fibrin gel is an effective method for reducing renal ischemia and operative duration.
  • This approach successfully preserves kidney function, offering a viable alternative to traditional suturing techniques.
  • Fibrin gel facilitates efficient renal hemostasis in sutureless LPN, potentially improving patient outcomes.