Pre-gerotal fat patch-A novel alternative to haemostatic agents during partial nephrectomy

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Partial nephrectomy (PN) is a standard procedure for renal tumors.
• Hemostatic agents are commonly used to control bleeding during PN.
• Alternative hemostatic techniques are sought to improve outcomes and reduce costs.

Purpose of the Study:

• To evaluate the efficacy of a pre-gerotal fat patch as a hemostatic bolster during open partial nephrectomy (PN).
• To compare the use of a fat patch with synthetic hemostatic agents in open PN.

Main Methods:

• A retrospective audit of 55 patients undergoing open PN with a pre-gerotal fat patch renorrhaphy was conducted.
• Data collected included patient demographics, operative details, and post-operative complications.
• The fat patch was harvested and placed over the renorrhaphy site after mass dissection and hemostasis.

Main Results:

• No renal bed bleeds, urine leaks, or urine fistulas were observed.
• Only one patient (1.9%) experienced a major complication (Clavien-Dindo IIIb) due to bleeding.
• Mean intraoperative blood loss was 355 mL, with a mean post-operative creatinine increase of 10.7 μmol/L.

Conclusions:

• A pre-gerotal fat patch is an effective and safe hemostatic technique for open PN.
• This method offers a cost-effective alternative to synthetic hemostatic agents.
• The technique adds minimal operative time and is associated with low complication rates.