title: Bovine serum albumin glutaraldehyde for completely sutureless laparoscopic heminephrectomy in a survival porcine model.
abstract: BACKGROUND
  Laparoscopic partial nephrectomy (LPN) has not received widespread clinical application because of its technical challenge. Bovine serum albumin glutaraldehyde (BSAG) is a hemostatic agent that is independent of the clotting cascade. We evaluated the use of BSAG as the sole agent for parenchymal and collecting system closure during LPN in a survival porcine model.
  
  
  METHODS
  Eighteen pigs underwent hilar clamping and LPN by longitudinal excision of the lateral one-third of the right kidney. The opened collecting system was covered with oxidized cellulose to prevent BSAG seepage into the urinary tract. BSAG was allowed to set for 10 or 5 minutes. Twelve animals underwent survival LPN BSAG only closure; six control pigs were acutely studied using saline. Urinary extravasation was evaluated by injection of furosemide and indigo carmine, and then evaluating the renal surface and bladder catheter drainage for dye. A subjective bleeding score was assigned after hilum unclamping. At 6 weeks, BSAG kidneys were harvested for burst pressure testing and histopathological analysis.
  
  
  RESULTS
  All 12 pigs survived for 6 weeks. No pigs had urinary extravasation. Mean percentage of kidney removed by weight was 19%. Mean warm ischemia time was 29 minutes. Five pigs required a second BSAG application to achieve a bleeding score of 0. Mean arterial and collecting system burst pressures were 301.8 and 322.4 mm Hg, respectively. Mean postoperative creatinine increase was 0.07 mg/dL.
  
  
  CONCLUSIONS
  BSAG for completely sutureless LPN in a survival porcine model was feasible.
authors.affiliation: Department of Urology, University of California Irvine, Orange, California 92868, USA. louie@uci.edu
authors.forename: Michael K
authors.initials: MK
authors.lastname: Louie
authors.forename: Aldrin Joseph R
authors.initials: AJ
authors.lastname: Gamboa
authors.forename: Adam G
authors.initials: AG
authors.lastname: Kaplan
authors.forename: Amanda
authors.initials: A
authors.lastname: Khosravi
authors.forename: Hung
authors.initials: H
authors.lastname: Truong
authors.forename: Lorena
authors.initials: L
authors.lastname: Andrade
authors.forename: Rachelle
authors.initials: R
authors.lastname: Lin
authors.forename: Reza
authors.initials: R
authors.lastname: Alipanah
authors.forename: Cervando
authors.initials: C
authors.lastname: Ortiz
authors.forename: David
authors.initials: D
authors.lastname: McCormick
authors.forename: Geoffrey N
authors.initials: GN
authors.lastname: Box
authors.forename: Hak J
authors.initials: HJ
authors.lastname: Lee
authors.forename: Leslie A
authors.initials: LA
authors.lastname: Deane
authors.forename: Robert A
authors.initials: RA
authors.lastname: Edwards
authors.forename: Elspeth M
authors.initials: EM
authors.lastname: McDougall
authors.forename: Ralph V
authors.initials: RV
authors.lastname: Clayman
mesh_terms: D000818:Animals; D005976:Glutaral / Q000737:chemistry / Q000627:therapeutic use*; D010535:Laparoscopy; D023421:Models, Animal; D009392:Nephrectomy / Q000379:methods*; D012710:Serum Albumin, Bovine / Q000737:chemistry / Q000627:therapeutic use*; D016019:Survival Analysis; D034421:Sus scrofa / Q000601:surgery*; D013537:Sutures
chemical_list: D012710:Serum Albumin, Bovine; D005976:Glutaral