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Using a Harmonic Scalpel “ Drilling and Clamping ” Method to Implement Zero Ischemic Robotic-assisted Partial Nephrectomy

View Article: PubMed Central - PubMed

ABSTRACT

Robot-assisted partial nephrectomy (RAPN) has gradually become a popular minimally invasive nephron-sparing surgical option for small renal tumors. Ischemic injury should be minimized because it impacts renal function outcomes following partial nephrectomy. Herein, the authors detail the technique and present initial perioperative outcomes of our novel harmonic scalpel “drilling and clamping” method to implement zero-ischemic RAPN. The authors prospectively collected baseline and perioperative data of patients who underwent zero ischemic RAPN performed by our harmonic scalpel “drilling and clamping” method. From April 2012 to December 2014, a total of 19 consecutive zero ischemic RAPN procedures were performed by a single surgeon. For 18 of the 19 patients, RAPN using our harmonic scalpel “Drilling and Clamping” method was successfully completed without the need for hilar clamping. The median tumor size was 3.4 cm (range: 1.8–6.2); operative time was 3.2 hours (range: 1.9–4.5); blood loss was 100 mL (range: 30–950); and postoperative hospital stay was 4 days (3–26). One patient required intraoperative blood transfusion. Two patients had intra or postoperative complications: 1 was converted to traditional laparotomy because of massive bleeding, whereas another had postoperative stress ulcer. Pathology confirmed renal cell carcinoma in 13 patients (63.2%), angiomyolipoma in 6 patients: (31.5%), and oncocytoma in 1 patient (5.3%). Mean pre- and postoperative serum creatinine (0.82 mg/dL and 0.85 mg/dL, respectively), estimated glomerular filtration rate (84.12 and 82.18, respectively), and hemoglobin (13.27 g/dL and 12.71 g/dL, respectively) were comparable. The authors present a novel zero-ischemic technique for RAPN. They believe that this technique is feasible and reproducible.

No MeSH data available.


Related in: MedlinePlus

Preoperative CT scans showing the renal tumor to be treated with zero ischemia robot-assisted partial nephrectomy: A 51-year-old female patient with a left 3.6 cm exophytic midpole renal tumor.
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Figure 1: Preoperative CT scans showing the renal tumor to be treated with zero ischemia robot-assisted partial nephrectomy: A 51-year-old female patient with a left 3.6 cm exophytic midpole renal tumor.

Mentions: The patients underwent a detailed medical history assessment, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and at 1 month after operation, while hemoglobin (Hb) was recorded preoperatively and at discharge day for this study. The modification of diet in renal disease (MDRD) was used for calculating the estimated glomerular filtration rate (eGFR). Before the operations were performed, all patients received three-dimensional abdominal computed tomography with 2 to 3-mm cuts to delineate the tumor location, depth, and the distance to the collecting system (Figure 1). Percentage change in serum creatinine, eGFR, and Hb were determined by calculating the difference between the preoperative and postoperative data. Bowel preparations were not necessary before the day of surgery.


Using a Harmonic Scalpel “ Drilling and Clamping ” Method to Implement Zero Ischemic Robotic-assisted Partial Nephrectomy
Preoperative CT scans showing the renal tumor to be treated with zero ischemia robot-assisted partial nephrectomy: A 51-year-old female patient with a left 3.6 cm exophytic midpole renal tumor.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4998241&req=5

Figure 1: Preoperative CT scans showing the renal tumor to be treated with zero ischemia robot-assisted partial nephrectomy: A 51-year-old female patient with a left 3.6 cm exophytic midpole renal tumor.
Mentions: The patients underwent a detailed medical history assessment, physical examination, and routine laboratory tests. Serum creatinine was recorded preoperatively and at 1 month after operation, while hemoglobin (Hb) was recorded preoperatively and at discharge day for this study. The modification of diet in renal disease (MDRD) was used for calculating the estimated glomerular filtration rate (eGFR). Before the operations were performed, all patients received three-dimensional abdominal computed tomography with 2 to 3-mm cuts to delineate the tumor location, depth, and the distance to the collecting system (Figure 1). Percentage change in serum creatinine, eGFR, and Hb were determined by calculating the difference between the preoperative and postoperative data. Bowel preparations were not necessary before the day of surgery.

View Article: PubMed Central - PubMed

ABSTRACT

Robot-assisted partial nephrectomy (RAPN) has gradually become a popular minimally invasive nephron-sparing surgical option for small renal tumors. Ischemic injury should be minimized because it impacts renal function outcomes following partial nephrectomy. Herein, the authors detail the technique and present initial perioperative outcomes of our novel harmonic scalpel “drilling and clamping” method to implement zero-ischemic RAPN. The authors prospectively collected baseline and perioperative data of patients who underwent zero ischemic RAPN performed by our harmonic scalpel “drilling and clamping” method. From April 2012 to December 2014, a total of 19 consecutive zero ischemic RAPN procedures were performed by a single surgeon. For 18 of the 19 patients, RAPN using our harmonic scalpel “Drilling and Clamping” method was successfully completed without the need for hilar clamping. The median tumor size was 3.4 cm (range: 1.8–6.2); operative time was 3.2 hours (range: 1.9–4.5); blood loss was 100 mL (range: 30–950); and postoperative hospital stay was 4 days (3–26). One patient required intraoperative blood transfusion. Two patients had intra or postoperative complications: 1 was converted to traditional laparotomy because of massive bleeding, whereas another had postoperative stress ulcer. Pathology confirmed renal cell carcinoma in 13 patients (63.2%), angiomyolipoma in 6 patients: (31.5%), and oncocytoma in 1 patient (5.3%). Mean pre- and postoperative serum creatinine (0.82 mg/dL and 0.85 mg/dL, respectively), estimated glomerular filtration rate (84.12 and 82.18, respectively), and hemoglobin (13.27 g/dL and 12.71 g/dL, respectively) were comparable. The authors present a novel zero-ischemic technique for RAPN. They believe that this technique is feasible and reproducible.

No MeSH data available.


Related in: MedlinePlus