Optimized haemostasis in nephron-sparing surgery using small-intestine submucosa.
BACKGROUND
The indications for nephron-sparing surgery are expanding constantly. One major contributing fact for this development is the improvement of haemostatic techniques following excision of the tumor. Nevertheless, postoperative bleeding complications still occur. To prevent this, we prospectively studied the effect of application of small-intestine submucosa (SIS) over the renal defect.


METHODS
We performed 55 nephron-sparing surgeries applying SIS between 08/03 and 10/06 in 53 pts. (mean age: 59 yrs., range 29 - 79 yrs.). After resection of the renal tumor and application of a haemostyptic agent, we used SIS to secure and apply compression on the defect.


RESULTS
The final pathology revealed clear-cell and papillary carcinoma, papillary adenoma, oncocytoma, and angiomyolipoma in 39 (70.9%), 6 (10.9), 1 (1.8%), 2 (3.6%) and 7 (12.7%) patients, respectively. The 45 malignant lesions (81.8%) were classified as pT1a and pT1b in 35 (77.8%) and 10 (22.2%) patients, respectively. The median tumor size was 4.5 cm (range: 1.3 - 13 cm). The median operating time was 186 min (range: 90 - 260 min). 18 (32.7%) procedures were performed without ischemia. 23 (41.8%) and 14 (25.5%) cases were operated in in-situ cold and warm ischemia, respectively. The median intraoperative blood loss was 730 cc (range: 100 - 2500 cc). No open operative revision was indicated due to postoperative bleeding complications. Furthermore, there was no necessity to substitute persistent blood loss from the drains postoperatively. No urinoma occurred.


CONCLUSIONS
SIS is a highly effective and easy-to-use instrument for preventing postoperative bleeding and urinary fistula complications in nephron-sparing surgery.
Simon
Jörg
J
Department of Urology, University of Ulm, Prittwitzstr, 43, 89075 Ulm, Germany. joerg.simon@uniklinik-ulm.de
de Petriconi
Robert
R
Meilinger
Michael
M
Hautmann
Richard E
RE
Bartsch
Georg
G
D000328:Adult; D000368:Aged; D000818:Animals; D001672:Biocompatible Materials; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007413:Intestinal Mucosa; D007421:Intestine, Small; D007680:Kidney Neoplasms / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons; D011446:Prospective Studies; D013552:Swine
D001672:Biocompatible Materials