Feasibility of laparoscopic partial nephrectomy using pledgeted compression sutures for hemostasis.
OBJECTIVE
To develop a technique for laparoscopic partial nephrectomy (LPN) without the use of hilar occlusion that allows large renal resection and excellent hemostasis.


METHODS
Five female domestic pigs underwent right laparoscopic transperitoneal lower-pole partial nephrectomy after placement of pledgeted parenchymal compression sutures tied intracorporeally to induce regional renal hypoperfusion. Postoperatively, serial serum creatinine measurements were obtained to monitor renal function. The pigs were allowed to recover and 2 weeks later underwent an identical procedure on the left side. The animals were sacrificed after the second procedure, and both renal units were removed for ex vivo retrograde urograms and histologic analysis.


RESULTS
The median operative time was 154.5 minutes (range 110-305 minutes), and the median blood loss was 137.5 mL (range 100-300 mL). On average, 35% (range 31%-36.8%) of the kidney was resected. All cases required use of adjunctive hemostatic clips to control bleeding from central vessels. All animals survived 2 weeks and had no evidence of urinary extravasation clinically or on ex vivo retrograde urograms.


CONCLUSIONS
In the porcine model, LPN with placement of pledgeted sutures allows resection of large renal segments, although technical refinements are required to improve hemostasis. Currently, the need for adjunctive hemostatic measures limits the initial clinical application of this technique to small, exophytic tumors.
Wilhelm
David M
DM
Clinical Center for Minimally Invasive Urologic Cancer Treatment, Department of Urology, The University of Texas Southwestern Medical Center, Dallas, Texas 75390-9110, USA.
Ogan
Kenneth
K
Saboorian
M H
MH
Napper
Cheryl
C
Pearle
Margaret S
MS
Cadeddu
Jeffrey A
JA
D000818:Animals; D003404:Creatinine / Q000097:blood; D005240:Feasibility Studies; D005260:Female; D015718:Fibrin Tissue Adhesive / Q000008:administration & dosage; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D007668:Kidney / Q000000981:diagnostic imaging / Q000473:pathology; D007677:Kidney Function Tests; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D009929:Organ Size; D011859:Radiography; D013536:Suture Techniques; D013537:Sutures; D013552:Swine
D015718:Fibrin Tissue Adhesive; D003404:Creatinine