The Hemostatic Bandage: Suture-Less Enucleation Partial Nephrectomy

Abstract

Introduction:

Renorrhaphy at the time of robot-assisted laparoscopic enucleation partial nephrectomy is technically challenging. ^{1 –3} Our objective is to describe a novel technique with suture-less renorrhaphy at the time of partial nephrectomy by use of a hemostatic bandage. These agents leverage various physiologic and artificial mechanisms to promote hemostasis. ⁴

Materials and Methods:

Our case presentation describes a 60-year-old male with a 3.1 cm exophytic left renal mass. He underwent retroperitoneal robot-assisted laparoscopic partial nephrectomy with enucleation of the tumor. The renal hilum was not clamped and there were no renorrhaphy stitches. A bandage consisting of Surgicel^®, Gelfoam^® soaked in thrombin, and Floseal^®, was used for hemostasis. In addition, we retrospectively analyze our institution's experience of using this technique for patients undergoing robot-assisted partial nephrectomy.

Results:

The procedure was effectively performed without complication. The patient had an uneventful postoperative course and shows no evidence of disease at 30 months follow-up. A total of 53 patients underwent suture-less partial nephrectomy at our institution from 2010 to 2015. None of these patients necessitated postoperative blood transfusion or embolization. Five patients had Clavien grade I complications.

Conclusions:

Suture-less nephron sparing surgery with use of a hemostatic bandage is a safe alternative to renorrhaphy. This technique can potentially lead to decreased parenchymal loss and warm ischemia time. Long-term outcomes and comparative studies are needed.

Acknowledgment:

This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors. The authors have received and archived patient consent for video recording/publication in advance of video recording of procedure.

No competing financial interests exist.

Runtime of video: 4 mins 57 secs

Presented at the American Urological Association, North Central Section Annual Meeting 2018, Chicago, IL.