Canadian Update on Surgical Procedures (CUSP) Urology Group consensus for intraoperative hemostasis during minimally invasive partial nephrectomy
| Autor: | Joshua Wiesenthal, Darrel E. Drachenberg, Hugues Widmer, Kevin C. Zorn, Christopher French, Christopher J.D. Wallis, Antonio Finelli, Blair St. Martin, Keith Barrett, Simon Possee, Neal Rowe, Jun Kawakami, Girish S. Kulkarni, Maurice Anidjar, Jason Lee, Geoffrey Gotto, Jeffrey McCracken, Jason P. Izard, Howard Evans, Raj Satkunasivam, Stephanie Tatzel, Patrick O. Richard, Brian P. T. Yang, Camilla Tajzler, Naji J. Touma, Thomas McGregor, Umesh Jain, Douglas C. Cheung, Anil Kapoor, Robert Sabbagh, Tom Deklaj |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
Guiding Principles business.industry Urology medicine.medical_treatment Gold standard 030232 urology & nephrology Delphi method MEDLINE Special Feature Surgical procedures Nephrectomy Checklist 03 medical and health sciences 0302 clinical medicine Oncology 030220 oncology & carcinogenesis Hemostasis Medicine business |
| Zdroj: | Can Urol Assoc J |
| ISSN: | 1911-6470 |
| Popis: | Introduction: Partial nephrectomy remains the gold standard in the management of small renal masses. However, minimally invasive partial nephrectomy (MIPN) is associated with a steep learning curve, and optimal, standardized techniques for time-efficient hemostasis are poorly described. Given the relative lack of evidence, the goal was to describe a set of actionable guiding principles, through an expert working panel, for urologists to approach hemostasis without compromising warm ischemia or oncological outcomes. Methods: A three-step modified Delphi method was used to achieve expert agreement on the best practices for hemostasis in MIPN. Panelists were recruited from the Canadian Update on Surgical Procedures (CUSP) Urology Group, which represent all provinces, academic and community practices, and fellowship- and non-fellowship-trained surgeons. Thirty-two (round 1) and 46 (round 2) panellists participated in survey questionnaires, and 22 attended the in-person consensus meeting. Results: An initial literature search of 945 articles (230 abstracts) underwent screening and yielded 24 preliminary techniques. Through sequential survey assessment and in-person discussion, a total of 11 strategies were approved. These are temporally distributed prior to tumor resection (five principles), during tumor resection (two principles), and during renorrhaphy (four principles). Conclusions: Given the variability in tumor size, depth, location, and vascularity, coupled with limitations of laparoscopic equipment, achieving consistent hemostasis in MIPN may be challenging. Despite over two decades of MIPN experience, limited evidence exists to guide clinicians. Through a three-step Delphi method and rigorous iterative review with a panel of experts, we ascertained a guiding checklist of principles for newly beginning and practicing urologists to reference. |
| Databáze: | OpenAIRE |
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