A comparison of running suture versus figure-8 sutures as the initial step in achieving hemostasis during laparoscopic partial nephrectomy.
OBJECTIVE
During laparoscopic partial nephrectomy, the importance of the initial suture placed under warm ischemic conditions cannot be underestimated. Inadequate hemostasis may lead to further surgical complications. Our goal was to determine which method of suture ligation (running vs figure-8 interrupted) provides better initial hemostasis when performing partial nephrectomy in an ex-vivo porcine model.


METHODS
Deep partial nephrectomy defects were cut in the lateral aspect of six porcine kidneys. The renal artery was cannulated, and the kidneys were perfused from a water reservoir. The level (cm H(2)O) at which parenchymal leakage occurred was measured and recorded in three situations: No parenchymal suture; running suture along the base of the defect; and interrupted figure-8 sutures placed in parallel along the base of the defect.


RESULTS
Six kidneys were studied. Using interrupted figure-8 sutures, the mean leak pressure was 56.7 cm H(2)O (over baseline). Using a running suture, the mean leak pressure was 147.5 cm H(2)O (over baseline). Mean values were compared using two-tailed t test and found to be statistically significant (P = 0.05).


CONCLUSIONS
In an ex-vivo porcine kidney model, use of a running suture along the base of a renal tumor defect (simulating that which is seen during partial nephrectomy) appears to allow for better initial hemostatic control, as compared with interrupted figure-8 sutures placed in parallel.
Rosenblatt
Gregory S
GS
Minimally Invasive Urology Institute, Cedars-Sinai Medical Center, Los Angeles, California 90048, USA.
Fuchs
Gerhard J
GJ
D000818:Animals; D001794:Blood Pressure / Q000502:physiology; D006488:Hemostasis, Surgical / Q000379:methods*; D007668:Kidney / Q000601:surgery; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D034421:Sus scrofa / Q000601:surgery; D013537:Sutures