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Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation tim...

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Autores principales: Li, Ching-Chia, Chien, Tsu-Ming, Huang, Shu-Pin, Yeh, Hsin-Chih, Lee, Hsiang-Ying, Ke, Hung-Lung, Wen, Sheng-Chen, Chang, Wei-Che, Juan, Yung-Shun, Chou, Yii-Her, Wu, Wen-Jeng
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697908/
https://www.ncbi.nlm.nih.gov/pubmed/33203025
http://dx.doi.org/10.3390/jcm9113658
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author Li, Ching-Chia
Chien, Tsu-Ming
Huang, Shu-Pin
Yeh, Hsin-Chih
Lee, Hsiang-Ying
Ke, Hung-Lung
Wen, Sheng-Chen
Chang, Wei-Che
Juan, Yung-Shun
Chou, Yii-Her
Wu, Wen-Jeng
author_facet Li, Ching-Chia
Chien, Tsu-Ming
Huang, Shu-Pin
Yeh, Hsin-Chih
Lee, Hsiang-Ying
Ke, Hung-Lung
Wen, Sheng-Chen
Chang, Wei-Che
Juan, Yung-Shun
Chou, Yii-Her
Wu, Wen-Jeng
author_sort Li, Ching-Chia
collection PubMed
description Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results.
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spelling pubmed-76979082020-11-29 Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors Li, Ching-Chia Chien, Tsu-Ming Huang, Shu-Pin Yeh, Hsin-Chih Lee, Hsiang-Ying Ke, Hung-Lung Wen, Sheng-Chen Chang, Wei-Che Juan, Yung-Shun Chou, Yii-Her Wu, Wen-Jeng J Clin Med Article Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results. MDPI 2020-11-13 /pmc/articles/PMC7697908/ /pubmed/33203025 http://dx.doi.org/10.3390/jcm9113658 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Li, Ching-Chia
Chien, Tsu-Ming
Huang, Shu-Pin
Yeh, Hsin-Chih
Lee, Hsiang-Ying
Ke, Hung-Lung
Wen, Sheng-Chen
Chang, Wei-Che
Juan, Yung-Shun
Chou, Yii-Her
Wu, Wen-Jeng
Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors
title Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors
title_full Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors
title_fullStr Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors
title_full_unstemmed Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors
title_short Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors
title_sort single-site sutureless partial nephrectomy for small exophytic renal tumors
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7697908/
https://www.ncbi.nlm.nih.gov/pubmed/33203025
http://dx.doi.org/10.3390/jcm9113658
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