Renal Vascular Clamp Placement: A Potential Cause of Incomplete Hilar Control during Partial Nephrectomy
| Autor: | Muhannad Alsyouf, Carol Conceicao, Daniel Faaborg, Herbert C. Ruckle, D. Duane Baldwin, Brandon Peplinski, David Tryon, Kristene Myklak, Javier L. Arenas |
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| Rok vydání: | 2016 |
| Předmět: |
Adult
Male medicine.medical_specialty Urology medicine.medical_treatment 030232 urology & nephrology Kidney Nephrectomy Constriction 03 medical and health sciences Renal Artery 0302 clinical medicine Robotic Surgical Procedures Cadaver medicine.artery medicine Humans Penrose drain Renal artery business.industry Equipment Design Surgery Clamp medicine.anatomical_structure 030220 oncology & carcinogenesis Laparoscopy Cadaveric spasm business Artery |
| Zdroj: | Journal of Urology. 195:756-762 |
| ISSN: | 1527-3792 0022-5347 |
| Popis: | Previous benchtop studies have shown that robotic bulldog clamps provide incomplete vascular control of a Penrose drain. We determined the efficacy of robotic and laparoscopic bulldog clamps to ensure hemostasis on the human renal artery. The effect of clamp position on vascular control was also examined.Fresh human cadaveric renal arteries were used to determine the leak point pressure of 7 bulldog clamps from a total of 3 manufacturers. Five trials were performed per clamp at 4 locations, including the fulcrum, proximal, middle and distal positions. Comparison was done using the Kruskal-Wallis test with p0.05 considered significant.None of the bulldog clamps leaked at a pressure less than 215 mm Hg when applied at the proximal, middle or distal position. In general leak point pressure decreased as the artery was positioned more distal along the clamp. The exception was when the vessel was placed at the fulcrum position. At that position 80% to 100% of trials with the Klein laparoscopic, 100% with the Klein robotic (Klein Robotic, San Antonio, Texas) and 60% to 80% with the Scanlan robotic (Scanlan International, Saint Paul, Minnesota) clamp leaked at pressure below 215 mm Hg.Each vascular clamp adequately occluded flow at physiological pressure when placed at the proximal, middle or distal position. Furthermore, these results demonstrate that there is leakage at physiological pressure when the artery is placed at the fulcrum of certain clamp types. These results suggest that applying a bulldog clamp at the fulcrum could potentially lead to inadequate vessel occlusion and intraoperative bleeding. |
| Databáze: | OpenAIRE |
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