Renal artery pseudoaneurysm following laparoscopic partial nephrectomy.
OBJECTIVE
We describe the presentation, evaluation and management of hemorrhage due to renal artery pseudoaneurysm following laparoscopic partial nephrectomy.


METHODS
Of the 345 laparoscopic partial nephrectomies performed by us during a 5-year period 6 patients (1.7%) had postoperative hemorrhage from a renal artery pseudoaneurysm. Patient charts were reviewed to identify pertinent preoperative, intraoperative and postoperative data.


RESULTS
Median tumor size was 3.5 cm (range 2.2 to 5), intraoperative blood loss was 175 cc (range 50 to 500), warm ischemia time was 32 minutes (range 30 to 45) and operative time was 3.8 hours (range 2.5 to 5). The mean percent of kidney excised was 31% and pelvicaliceal system entry was suture repaired in all 6 patients. No patient required blood transfusion perioperatively. Average hospital stay was 3.4 days (range 2.5 to 6). Delayed postoperative hemorrhage occurred at a median of 12 days (range 8 to 15). Angiography revealed a renal artery pseudoaneurysm most commonly at a third or fourth order branch (4 and 2 patients, respectively). Percutaneous embolization was successful in each patient.


CONCLUSIONS
Renal artery pseudoaneurysm is an uncommon complication following laparoscopic partial nephrectomy. These patients often present in delayed fashion. Selective angiographic embolization is the initial treatment of choice.
Singh
Dinesh
D
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
Gill
Inderbir S
IS
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017541:Aneurysm, False / Q000000981:diagnostic imaging / Q000209:etiology* / Q000628:therapy; D000792:Angiography; D018207:Angiomyolipoma / Q000601:surgery; D002292:Carcinoma, Renal Cell / Q000601:surgery; D004621:Embolization, Therapeutic; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects* / Q000379:methods*; D009820:Ohio; D019106:Postoperative Hemorrhage / Q000209:etiology / Q000628:therapy; D012077:Renal Artery / Q000000981:diagnostic imaging / Q000473:pathology*; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome