Abstract
Objective
We describe a new technique that can easily be used as a tension-free practical alternative in closing the renal defects resulting after open partial nephrectomy (PN).
Methods
A new technique (called “lipocorticoplasty”) where “wrapped fatty tissue” was placed in the tumor crater to close the renal defects that occur following PN is reported in 10 consecutive patients who underwent PN between May 2006 and January 2009 (Group I). Patients were compared with equal number of consecutive patients who underwent standard open PN before January 2009 (Group II) in terms of operative time, bleeding, tumor size, drain removal time, postoperative length of stay (PLOS), complications, and functional and oncological follow-up. Postoperative follow-up included physical examination, laboratory tests, and radiological screening at 3-month intervals for the first year, at 6-month intervals for the second year, and annually thereafter.
Results
Mean tumor size (35.2 vs. 33.8 mm), operative time (156 vs. 165 min), bleeding (650 vs. 765 cc), drain removal time (2.8 vs. 2.5 POD), and PLOS (4.4 vs. 4.2 POD) were not statistically different between Group I and Group II, respectively. No intraoperative complications occurred. Postoperatively, transient complications without any permanent sequela were observed in 3 (1 in Group I and 2 in Group II) patients. Mean follow-up time was 16.1 months (7–26) in Group I and 19.1 months (8–36) in Group II. None of the patients had local or systemic recurrence at follow-up.
Conclusion
Our new technique provides obvious benefits in local hemostasis, simplifies parenchymal suturing, obviates the need for coaptation of the edges of the tumor bed defect under tension, and minimizes nephron loss due to kinking and tearing of renal parenchyma in the closure of the renal defects following open renal tumor excision.
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References
Oakley NE, Hegarty NJ, McNeill A, Gill IS (2006) Minimally invasive nephron-sparing surgery for renal cell cancer. BJU Int 98(2):278–284
Van Poppel H, Da Pozzo L, Albrecht W et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 51:1606–1615
Lau WK, Blute ML, Weaver AL, Torres VE, Zincke H (2000) Matched comparison of radical nephrectomy vs. nephron-sparing surgery in patients with unilateral renal cell carcinoma and a normal contralateral kidney. Mayo Clin Proc 75(12):1236–1242
Butler BP, Novick AC, Miller DP, Campbell SA, Licht MR (1995) Management of small unilateral renal cell carcinomas: radical versus nephron-sparing surgery. Urology 45(1):34–40
Patard JJ, Shvarts O, Lam JS et al (2004) Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol 171(6 Pt 1):2181–2185
Fergany AF, Hafez KS, Novick AC (2003) Long term results of nephron sparing surgery for localized renal cell carcinoma: 10 year follow up. J Urol 163:442–445
Miller DC, Hollingsworth JM, Hafez KS, Daignault S, Hollenbeck BK (2006) Partial nephrectomy for small renal masses: an emerging quality of care concern? J Urol 175(3 pt 1):853–858
Leibovich BC, Blute ML, Cheville JC, Lohse CM, Weaver AL, Zincke H (2004) Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol 171:1066–1070
Clark PE, Schover LR, Uzzo RG, Hafez KS, Rybicki LA, Novick AC (2001) Quality of life and psychological adaptation after surgical treatment for localized renal cell carcinoma: impact of the amount of remaining renal tissue. Urology 57(2):252–256
Shinohara N, Harabayashi T, Sato S, Hioka T, Tsuchiya K, Koyanagi T (2001) Impact of nephron-sparing surgery on quality of life in patients with localized renal cell carcinoma. Eur Urol 39(1):114–119
Hidas G, Kastin M, Mullerad M, Shental J, Moskovitz B, Nativ O (2006) Sutureless nephron-sparing surgery: use of albumin glutaraladehyde tissue adhesive (BioGlue). Urology 67(4):697–700
Levinson AK, Swanson DA, Johnson DE, Greskovich FJ III, Stephenson RA, Lichtiger B (1991) Fibrin glue for partial nephrectomy. Urology 38(4):314–316
Urlesberger H, Rauchenwald K, Henning K (1979) Fibrin adhesives in surgery of the renal parenchyma. Eur Urol 5(4):260–261
Lapini ACM, Sereni S, Stefanucci S et al (1994) The use of fibrin sealant in nephron sparing surgery for renal tumor. In: Schlag G, Melchior H, Wallwiener D (eds) Gynecology and obstetric urology, vol 7. Springer, New York, pp 79–80
Gill IS, Ramani AP, Spaliviero M, Xu M, Finelli A, Kaouk JH, Desai MM (2005) Improved hemostasis during laparoscopic partial nephrectomy using gelatin matrix thrombin sealant. Urology 65(3):463–466
Shekarriz B, Stoller ML (2002) The use of fibrin sealant in urology. J Urol 167(3):1218–1225
Ramakumar S, Roberts WW, Fugita OE, Colegrove P, Nicol TM, Jarrett TW, Kavoussi LR, Slepian MJ (2002) Local hemostasis during laparoscopic partial nephrectomy using biodegradable hydrogels: initial porcine results. J Endourol 16(7):489–494
Wilhelm DM, Ogan K, Saboorian MH, Napper C, Pearle MS, Cadeddu JA (2003) Feasibility of laparoscopic partial nephrectomy using pledgeted compression sutures for hemostasis. J Endourol 17(4):223–227
Gill IS, Desai MM, Kaouk JH, Meraney AM, Murphy DP, Sung GT, Novick AC (2002) Laparoscopic partial nephrectomy for renal tumor: duplicating open surgical techniques. J Urol 167(2 Pt 1):469–476; discussion 475–476
Billings E Jr, May JW Jr (1989) Historical review and present status of free fat graft autotransplantation in plastic and reconstructive surgery. Plast Reconstr Surg 83:368–381
Nguyen CT, Campbell SC, Novick AC (2008) Choice of operation for clinically localized renal tumor. Urol Clin North Am 35(4):645–655
Novick AC (1993) Renal-sparing surgery for renal cell carcinoma. Urol Clin North Am 20(2):277–282
Janetschek G, Daffner P, Peschel R, Bartsch G (1998) Laparoscopic nephron sparing surgery for small renal cell carcinoma. J Urol 159(4):1152–1155
Siemer S, Lahme S, Altziebler S et al (2007) Efficacy and safety of TachoSil as haemostatic treatment versus standard suturing in kidney tumour resection: a randomised prospective study. Eur Urol 52(4):1156–1163
Corman JM, Penson DF, Hur K, Khuri SF, Daley J, Henderson W, Krieger JN (2000) Comparison of complications after radical and partial nephrectomy: results from the National Veterans Administration Surgical Quality Improvement Program. BJU Int 86(7):782–789
Herr HW (1999) Partial nephrectomy for unilateral renal carcinoma and a normal contralateral kidney: 10-year followup. J Urol 161(1):33–34
Shekarriz B, Upadhyay J, Shekarriz H, de Assis Mendes Goes F Jr, Bianco FJ, Tiguert R, Gheiler E, Wood DP Jr (2002) Comparison of costs and complications of radical and partial nephrectomy for treatment of localized renal cell carcinoma. Urology 59(2):211–215
Ghavamian R, Zincke H (2001) Open surgical partial nephrectomy. Semin Urol Oncol 19(2):103–113
Heye S, Maleux G, Van Poppel H, Oyen R, Wilms G (2005) Hemorrhagic complications after nephron-sparing surgery: angiographic diagnosis and management by transcatheter embolization. AJR Am J Roentgenol 184(5):1661–1664
Filipas D, Fichtner J, Spix C, Black P, Carus W, Hohenfellner R, Thüroff JW (2000) Nephron-sparing surgery of renal cell carcinoma with a normal opposite kidney: long-term outcome in 180 patients. Urology 56(3):387–392
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Ozkan, L., Saribacak, A., Taneri, C. et al. A new technique—“lipocorticoplasty”—for the closure of partial nephrectomy defects and its comparison with the standard technique. Int Urol Nephrol 43, 737–742 (2011). https://doi.org/10.1007/s11255-011-9899-8
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DOI: https://doi.org/10.1007/s11255-011-9899-8