Abdullah Newaj, Rahbar Haider, Barod Ravi, Dalela Deepansh, Larson Jeff, Johnson Michael, Mass Alon, Zargar Homayoun, Kaouk Jihad, Allaf Mohamad, Bhayani Sam, Stifelman Michael, Rogers Craig
Vattikutti Urology Institute, Henry Ford Health System, 2799 West Grand Boulevard, Detroit, MI, 48202, USA.
Division of Urology, Washington University in St. Louis, St. Louis, MO, USA.
J Robot Surg. 2017 Mar;11(1):47-51. doi: 10.1007/s11701-016-0611-y. Epub 2016 Jun 21.
A Satinsky clamp may be a backup option for hilar clamping during robotic partial nephrectomy (RPN) if there are challenges with application of bulldog clamps, but there are potential safety concerns. We evaluate outcomes of RPN using Satinsky vs. bulldog clamps, and provide tips for safe use of the Satinsky as a backup option. Using a multi-center database, we identified 1073 patients who underwent RPN between 2006 and 2013, and had information available about method of hilar clamping (bulldog clamp vs. Satinsky clamp). Patient baseline characteristics, tumor features, and perioperative outcomes were compared between the Satinsky and bulldog clamp groups. A Satinsky clamp was used for hilar clamping in 94 (8.8 %) RPN cases, and bulldog clamps were used in 979 (91.2 %) cases. The use of a Satinsky clamp was associated with greater operative time (198 vs. 175 min, p < 0.001), estimated blood loss (EBL, 200 vs. 100 ml, p < 0.001), warm ischemia time (WIT, 20 vs. 19 min, p = 0.036), transfusion rate (12.8 vs. 4.8 %, p = 0.001), and hospital stay (3 vs. 2 days, p < 0.001). Tumor characteristics and number of renal vessels were similar between groups. There were six intraoperative complications in the Satinsky clamp group, but none were directly related to the Satinsky clamp. On multivariable analysis, the use of the Satinsky clamp was not associated with increase in intraoperative or Clavien ≥3 postoperative complications, positive surgical margin rate or percentage change in estimated glomerular filtration rate. A Satinsky clamp can be a backup option for hilar clamping during challenging RPN cases, but requires careful technique, and was rarely necessary.
在机器人辅助部分肾切除术（RPN）中，如果使用牛头夹遇到困难，Satinsky夹可作为肾门阻断的备用选择，但存在潜在安全问题。我们评估了使用Satinsky夹与牛头夹进行RPN的结果，并提供安全使用Satinsky夹作为备用选择的技巧。利用多中心数据库，我们确定了2006年至2013年间接受RPN且有肾门阻断方法（牛头夹与Satinsky夹）相关信息的1073例患者。比较了Satinsky夹组和牛头夹组的患者基线特征、肿瘤特征及围手术期结果。94例（8.8%）RPN病例使用Satinsky夹进行肾门阻断，979例（91.2%）病例使用牛头夹。使用Satinsky夹与更长的手术时间（198分钟对175分钟，p<0.001）、估计失血量（EBL，200毫升对100毫升，p<0.001）、热缺血时间（WIT，20分钟对19分钟，p=0.036）、输血率（12.8%对4.8%，p=0.001）及住院时间（3天对2天，p<0.001）相关。两组间肿瘤特征和肾血管数量相似。Satinsky夹组有6例术中并发症，但均与Satinsky夹无直接关联。多变量分析显示，使用Satinsky夹与术中或Clavien≥3级术后并发症增加、手术切缘阳性率或估计肾小球滤过率百分比变化无关。在具有挑战性的RPN病例中，Satinsky夹可作为肾门阻断的备用选择，但需要谨慎操作，且很少有必要使用。
