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.jpg): Failed to open stream: No such file or directory in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 117 Medicine+(Baltimore)
2016 ; 95
(3
): e2349
Nephropedia Template TP
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Using a Harmonic Scalpel "Drilling and Clamping" Method to Implement Zero
Ischemic Robotic-assisted Partial Nephrectomy: An Observation Case Report Study
#MMPMID26817867
Medicine (Baltimore)
2016[Jan]; 95
(3
): e2349
PMID26817867
show ga
Robot-assisted partial nephrectomy (RAPN) has gradually become a popular
minimally invasive nephron-sparing surgical option for small renal tumors.
Ischemic injury should be minimized because it impacts renal function outcomes
following partial nephrectomy. Herein, the authors detail the technique and
present initial perioperative outcomes of our novel harmonic scalpel "drilling
and clamping" method to implement zero-ischemic RAPN. The authors prospectively
collected baseline and perioperative data of patients who underwent zero ischemic
RAPN performed by our harmonic scalpel "drilling and clamping" method. From April
2012 to December 2014, a total of 19 consecutive zero ischemic RAPN procedures
were performed by a single surgeon. For 18 of the 19 patients, RAPN using our
harmonic scalpel "Drilling and Clamping" method was successfully completed
without the need for hilar clamping. The median tumor size was 3.4?cm (range:
1.8-6.2); operative time was 3.2 hours (range: 1.9-4.5); blood loss was 100?mL
(range: 30-950); and postoperative hospital stay was 4 days (3-26). One patient
required intraoperative blood transfusion. Two patients had intra or
postoperative complications: 1 was converted to traditional laparotomy because of
massive bleeding, whereas another had postoperative stress ulcer. Pathology
confirmed renal cell carcinoma in 13 patients (63.2%), angiomyolipoma in 6
patients: (31.5%), and oncocytoma in 1 patient (5.3%). Mean pre- and
postoperative serum creatinine (0.82?mg/dL and 0.85?mg/dL, respectively),
estimated glomerular filtration rate (84.12 and 82.18, respectively), and
hemoglobin (13.27?g/dL and 12.71?g/dL, respectively) were comparable. The authors
present a novel zero-ischemic technique for RAPN. They believe that this
technique is feasible and reproducible.