Bovine serum albumin glutaraldehyde for completely sutureless laparoscopic heminephrectomy in a survival porcine model.
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.
Louie
Michael K
MK
Department of Urology, University of California Irvine, Orange, California 92868, USA. louie@uci.edu
Gamboa
Aldrin Joseph R
AJ
Kaplan
Adam G
AG
Khosravi
Amanda
A
Truong
Hung
H
Andrade
Lorena
L
Lin
Rachelle
R
Alipanah
Reza
R
Ortiz
Cervando
C
McCormick
David
D
Box
Geoffrey N
GN
Lee
Hak J
HJ
Deane
Leslie A
LA
Edwards
Robert A
RA
McDougall
Elspeth M
EM
Clayman
Ralph V
RV
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
D012710:Serum Albumin, Bovine; D005976:Glutaral