title: [The use of Surgisis® optimizes and simplifies partial nephrectomy for large renal tumors].
abstract: BACKGROUND
  With lower rates of postoperative renal failure, diabetes and cardiovascular disease, partial nephrectomy achieves longer overall survival and equally long tumor-specific survival. It is thus the current gold standard treatment for renal tumors and now also for those ≥ 4 cm in size. The main complications of nephron-sparing surgery, particularly for large and centrally located tumors, are postoperative parenchymal bleeding and urinary fistulas after opening the urinary collecting system (UCS).
  
  
  METHODS
  Between August 2003 and April 2012, 76 partial nephrectomies for tumors ≥ 4 cm in size were performed using porcine small intestinal submucosa (SIS, Surgisis®) to close the capsular, renal and in some cases, UCS defects.
  
  
  RESULTS
  The median tumor size was 5.0 cm (range 4.0-13.0 cm) and the intervention was performed with warm ischemia in 25 cases (32.8 %), with cold perfusion in 16 cases (21.2 %) and without ischemia in 35 cases (46.0 %). A total of 4 patients (5.5 %) developed postoperative urinary fistulas and 4 (5.5 %) required revision surgery because of significant postoperative bleeding. There were no local infections or allergic reactions to the foreign material.
  
  
  CONCLUSIONS
  Surgisis® enables a quick and technically uncomplicated closure of the renal defect after partial nephrectomy for tumors. It has the potential to further minimize postoperative bleeding and urinary fistulas and to facilitate the intervention to the extent that nephron-sparing surgery will gain broader acceptance even in patients with tumors ≥4 cm in size.
authors.affiliation: Klink für Urologie, Universitätsklinikum Ulm, Prittwitzstraße 43, Ulm, Germany. thomas.schnoeller@gmail.com
authors.forename: T J
authors.initials: TJ
authors.lastname: Schnoeller
authors.forename: R
authors.initials: R
authors.lastname: de Petriconi
authors.forename: R
authors.initials: R
authors.lastname: Hefty
authors.forename: F
authors.initials: F
authors.lastname: Jentzmik
authors.forename: A
authors.initials: A
authors.lastname: Al Ghazal
authors.forename: J
authors.initials: J
authors.lastname: Steinestel
authors.forename: J
authors.initials: J
authors.lastname: Mueller
authors.forename: F
authors.initials: F
authors.lastname: Zengerling
authors.forename: M
authors.initials: M
authors.lastname: Schrader
authors.forename: A J
authors.initials: AJ
authors.lastname: Schrader
mesh_terms: D001672:Biocompatible Materials; D001684:Biological Dressings; D001705:Bioprosthesis; D002292:Carcinoma, Renal Cell / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D050377:Cold Ischemia; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D008297:Male; D009364:Neoplasm Recurrence, Local / Q000000981:diagnostic imaging / Q000473:pathology / Q000601:surgery; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000000981:diagnostic imaging / Q000401:mortality / Q000517:prevention & control; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D051437:Renal Insufficiency / Q000517:prevention & control; D012086:Reoperation; D015996:Survival Rate; D014057:Tomography, X-Ray Computed; D014548:Urinary Fistula / Q000517:prevention & control; D052096:Warm Ischemia; D055815:Young Adult
chemical_list: D001672:Biocompatible Materials