V5-03: MINIMIZING WARM ISCHEMIA DURING ROBOTIC ASSISTED PARTIAL NEPHRECTOMY
VideoIntroductions and Objectives
To evaluate the efficacy of our approach in minimizing warm ischemia during robotic assisted partial nephrectomy (RAPN).
We retrospectively evaluated data of patients who underwent RAPN at a single institution by a single surgeon. After IRB approval patient charts were queried for all pertinent patient data which included demographic and perioperative data. Nephrometry score was calculated for all patients. Pathologic data and postoperative complications were also recorded. Patients who underwent an off clamp partial nephrectomy were excluded from analysis. With the intent to minimize warm ischemia V−loc suture was used to over sew the resection bed as well as a single running V−loc suture was used to reapproximate the kidney parenchyma (renorrhaphy) in a horizontal mattress fashion using the sliding hem−o−lok technique.
From September 2011 to August, 2013 a total of 48 patients underwent RAPN. The mean age was 67.2 years. Male to female ratio was: 2:1. The average ASA score was 2.6≈3: The mean nephrometry score was 6. The median warm ischemia time was 14 minutes and mean estimated blood loss was 129cc. There were no conversions to open however, the procedure was converted to a radical nephrectomy in 3 cases due to concern for incomplete tumor resection. Clear renal cell carcinoma (RCC) was the predominant pathology (68.8%). Positive margin was recorded in 1 (2%) patient. Overall there were two complications (4%) – delayed hemorrhage with negative angiogram and a delayed urinary fistula requiring percutaneous drain placement. By using linear regression analysis, no significant predictive effect of nephrometry score on duration of WIT in our patients (odds ratio: 0.8, 95% CI (−0.145 to 1.7), p=0.094.
Single suture renorrhaphy using V−loc suture performed during robotic partial nephrectomy is helpful in shortening the warm ischemia time with no increased risk of bleeding or urine leak.