Department of Urologic Surgery, The E. Wolfson Medical Center, Holon and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
Int Braz J Urol. 2012 Jan-Feb;38(1):84-8. doi: 10.1590/s1677-55382012000100012.
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.
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.
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.
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.
腹腔镜部分肾切除术（LPN）近年来越来越受欢迎，尽管它仍然是一项具有挑战性的手术。在此，我们描述了一种仅使用缝线进行止血的肾脏缺损闭合技术，用于 LPN 中。
肾脏经腹腔以标准方式进入。夹闭肾动脉并切除肿瘤后，用两层无结缝线分别闭合缺损。深层缝线连续，涉及深层实质，包括如果打开的集合系统。浅层缝线仅使用一个实质边缘的可吸收夹来接近缺损边缘。不使用支撑物、胶水或其他额外的止血剂。
目前该技术已应用于 34 例患者。肿瘤大小为 17-85mm。中位热缺血时间为 23 分钟（范围为 12-45），估计失血量为 55 毫升（30-1000）。术中无并发症或转为开放手术。未观察到尿漏或术后出血。
这种简化的技术似乎可靠且快速，因此可能对许多泌尿科医生具有吸引力。此外，避免常规使用额外的止血措施可能会为这种方法带来经济优势，而不会影响手术结果。
