title: Simplified hemostatic technique during laparoscopic partial nephrectomy.
abstract: BACKGROUND
  Laparoscopic partial nephrectomy (LPN) has gained popularity in recent years, although it remains a challenging procedure. Herein we describe our technique of renal defect closure using sutures as the sole means of hemostasis during LPN.
  
  
  METHODS
  The kidney is approached transperitoneally in a standard fashion. After the renal artery is clamped and the tumor has been excised, the defect is closed in two separate knot-free suture layers. The deep layer suture is continuous and involves deep parenchyma including the collecting system, if opened. The superficial layer suture approximates the margins of the defect using absorbable clips on one parenchymal edge only. No bolsters, glues or other additional hemostatic agents are used.
  
  
  RESULTS
  At present this technique was applied in 34 patients. Tumor size ranged from 17-85 mm. Median warm ischemia time was 23 min (range 12-45) and estimated blood loss 55 mL (30-1000). There were no intraoperative complications or conversions to open surgery. No urine leaks or postoperative bleedings were observed.
  
  
  CONCLUSIONS
  This simplified technique appears reliable and quick, and therefore may be attractive for many urologic surgeons. Furthermore, the avoidance of routine use of additional hemostatic maneuvers may provide an economical advantage to this approach with no compromise of the surgical outcome.
authors.affiliation: Department of Urologic Surgery, The E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. atsivian@hotmail.com
authors.forename: Alexander
authors.initials: A
authors.lastname: Tsivian
authors.forename: Matvey
authors.initials: M
authors.lastname: Tsivian
authors.forename: Shalva
authors.initials: S
authors.lastname: Benjamin
authors.forename: Ami A
authors.initials: AA
authors.lastname: Sidi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D019106:Postoperative Hemorrhage; D013536:Suture Techniques; D013537:Sutures / Q000592:standards; D016896:Treatment Outcome