The evolution of tumor enucleation partial nephrectomy: A comparison of perioperative outcomes for sutureless hemostatic bandage as an alternative to standard renorrhaphy.

Autor: Rac G; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., Ellis JL; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., Lanzotti NJ; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., McCormick ME; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., Felice MD; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., Janakiraman S; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., Desai S; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., Halgrimson W; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA., Patel HD; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA.; Department of Urology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA., Gupta GN; Department of Urology, Loyola University Medical Center, Maywood, Illinois, USA.; Department of Radiology, Loyola University Medical Center, Maywood, Illinois, USA.; Department of Surgery, Loyola University Medical Center, Maywood, Illinois, USA.
Jazyk: angličtina
Zdroj: Journal of surgical oncology [J Surg Oncol] 2024 Sep; Vol. 130 (3), pp. 653-658. Date of Electronic Publication: 2024 Jul 11.
DOI: 10.1002/jso.27775
Abstrakt: Background: The standard approach to hemostasis during partial nephrectomy (PN) is to perform suture renorrhaphy (SR). Application of a hemostatic bandage (HB) is an alternative to minimize blood loss and devitalized renal parenchyma. We aim to evaluate perioperative outcomes of PN with tumor enucleation (TE) comparing SR to HB.
Methods: We analyzed a retrospective cohort of 195 patients undergoing robot-assisted laparoscopic PN with TE performed at a tertiary referral center (2012-2022). Hemostasis was obtained with SR in 54 patients while 141 patients underwent application of HB consisting of Surgicel®, Gelfoam® soaked in thrombin, and Floseal®.
Results: SR patients had tumors of greater complexity by RENAL nephrometry score compared to HB patients (p < 0.001). Operative time (141 vs. 183 min, p < 0.001), warm ischemia time (11.6 vs. 24.2 min, p < 0.001), estimated blood loss (37 vs. 214 mL, p < 0.001), and length of stay (1.2 vs. 1.8 days, p < 0.001) favored HB. There was no significant difference in Clavien-Dindo grade ≥3 complications (p = 0.22). Renal function was comparable with mean estimated glomerular filtration rate decrease of 0.66 and 0.54 mL/min/1.73 m 2 at 3 months postoperatively for HB and SR, respectively (p = 0.93).
Conclusions: Application of an HB is a safe alternative to SR for hemostasis following PN with TE in appropriately selected patients.
(© 2024 Wiley Periodicals LLC.)
Databáze: MEDLINE
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