title: Temporary targeted hemostasis to facilitate bloodless partial nephrectomy.
abstract: OBJECTIVE
  To extend previous robotic-assisted techniques developed in the swine model to studies of laparoscopic and open partial nephrectomy conducted in pigs and calves, designed to encompass vessel diameters similar to those encountered in humans. Lumagel (Pluromed, Woburn, MA), a nontoxic polymer, can be administered intra-arterially under fluoroscopic guidance to obtain a bloodless operative field during partial nephrectomy while maintaining normal circulation to uninvolved renal tissue.
  
  
  METHODS
  A total of 10 animals (7 pigs and 3 calves) underwent flow interruption to the kidney, 2 with cross-clamping of the main renal artery, the remaining with Lumagel. Other than the first pig and calf, all the animals then underwent partial nephrectomy.
  
  
  RESULTS
  Using Lumagel, targeted blood flow interruption was achieved and circulation to the uninvolved renal tissue was maintained. Hemostasis lasted for ≥30 minutes. The surgical resection time averaged 11 minutes (range 10-13) and 23.3 minutes (range 9-40) in the open and laparoscopic groups, respectively. The estimated blood loss was negligible, with the exception of 2 cases, 1 in which an error in angiographic assessment led to an unoccluded vessel near the resection site and a second case in which a guidewire was inadvertently passed through a vessel. The interval to complete flow return, as determined by direct visualization of the kidney and its corresponding angiogram, averaged 7 and 2.5 minutes for Lumagel and arterial clamping, respectively.
  
  
  CONCLUSIONS
  Lumagel provides reliable and reproducible intraluminal blood flow interruption and flow restoration in both main and segmental renal arteries. By providing blood-free resection, the techniques described could facilitate partial nephrectomy without global renal ischemia.
authors.affiliation: Department of Urology, Lahey Clinic, Burlington, Massachusetts 01805, USA.
authors.forename: Niall J
authors.initials: NJ
authors.lastname: Harty
authors.forename: Alireza
authors.initials: A
authors.lastname: Moinzadeh
authors.forename: Sebastian
authors.initials: S
authors.lastname: Flacke
authors.forename: Jeffrey
authors.initials: J
authors.lastname: Pettit
authors.forename: James A
authors.initials: JA
authors.lastname: Benn
authors.forename: John A
authors.initials: JA
authors.lastname: Libertino
authors.forename: Peter N
authors.initials: PN
authors.lastname: Madras
mesh_terms: D015901:Angiography, Digital Subtraction; D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D002417:Cattle; D003287:Contrast Media / Q000008:administration & dosage; D005240:Feasibility Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D007472:Iohexol / Q000008:administration & dosage*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D059351:Organ Sparing Treatments; D020442:Poloxamer / Q000008:administration & dosage*; D012077:Renal Artery / Q000000981:diagnostic imaging; D013552:Swine
chemical_list: D003287:Contrast Media; C569797:Lumagel; D020442:Poloxamer; D007472:Iohexol