Abstract
Purpose
Postoperative management of minimally invasive partial nephrectomy (MIPN) without drain placement is common, but the effects on patients are unclear. We investigated the impact of no drain placement after MIPN.
Methods
We retrospectively studied 194 consecutive patients who underwent laparoscopic and robotic partial nephrectomy at one academic center. The study group included 46 evaluable patients without drain placement. The quantity of postoperative fluid collection in the perirenal space was calculated using computed tomography. The preoperative and postoperative serum concentrations of total protein, albumin, neutrophils, lymphocytes, monocytes numbers, and C-reactive protein (CRP) levels in the blood were compared between groups.
Results
Drains were placed in 148 (76.3 %) patients who underwent MIPN. The remaining 46 (23.7 %) patients did not have drain placement. Although the average total quantity of fluid discharged from the drain was 214 mL, the average fluid remaining in the perirenal space did not significantly differ with or without drain placement (20.3 vs. 16.8 mL, p = 0.64). The decrease in serum total protein and albumin was significantly greater with drain placement than without (total protein: 18.9 vs. 12.2 %, p < 0.001; and albumin: 24.7 vs. 22 %, p = 0.038). No drain placement also caused markedly greater decreases in lymphocytes and monocytes than did drain placement, whereas neutrophils and CRP did not differ based on drain placement.
Conclusion
Analysis of the quantity of fluid collection showed little need for routine drain placement. Not placing a drain after MIPN prevented serum protein loss and possibly accelerated wound-healing immune responses.
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References
Lane BR, Campbell SC, Gill IS (2013) 10-year oncologic outcomes after laparoscopic and open partial nephrectomy. J Urol 190:44–49. doi:10.1016/j.juro.2012.12.102
Abreu AL, Berger AK, Aron M, Ukimura O, Stein RJ, Gill IS, Desai MM (2013) Minimally invasive partial nephrectomy for single versus multiple renal tumors. J Urol 189:462–467. doi:10.1016/j.juro.2012.09.039
Abaza R, Prall D (2013) Drain placement can be safely omitted after the majority of robotic partial nephrectomies. J Urol 189:823–827. doi:10.1016/j.juro.2012.08.236
Poon CM, Leong HT (2009) Abdominal drain causing early small bowel obstruction after laparoscopic colectomy. JSLS J Soc Laparoendosc Surg Soc Laparoendosc Surg 13:625–627
Stawicki SP, Evans DC, Cipolla J, Seamon MJ, Lukaszczyk JJ, Prosciak MP, Torigian DA, Doraiswamy VA, Yazzie NP, Gunter OL Jr, Steinberg SM (2009) Retained surgical foreign bodies: a comprehensive review of risks and preventive strategies. Scand J Surg 98(1):8–17
Takagi T, Kondo T, Tajima T, Campbell SC, Tanabe K (2014) Enhanced computed tomography after partial nephrectomy in early postoperative period to detect asymptomatic renal artery pseudoaneurysm. Int J Urol 21:880–885. doi:10.1111/iju.12462
Shiroki R, Maruyama T, Kusaka M, Washida S, Hikichi M, Morikawa T, Hirano Y, Fukami N, Sasaki H, Ishikawa K, Hoshinaga K (2011) Robot-assisted laparoscopic partial nephrectomy using daVinci S-surgical system for localized renal tumor: report of initial five cases (Nihon Hinyokika Gakkai Zasshi). Jpn J Urol 102:679–685
Kosuga T, Hiki N, Nunobe S, Noma H, Honda M, Tanimura S, Sano T, Yamaguchi T (2014) Feasibility and nutritional impact of laparoscopy-assisted subtotal gastrectomy for early gastric cancer in the upper stomach. Ann Surg Oncol 21:2028–2035. doi:10.1245/s10434-014-3520-1
Eaglstein WH, Davis SC, Mehle AL, Mertz PM (1988) Optimal use of an occlusive dressing to enhance healing. Effect of delayed application and early removal on wound healing. Arch Dermatol 124:392–395
Kannon GA, Garrett AB (1995) Moist wound healing with occlusive dressings. A clinical review. Dermatol Surg 21:583–590
Ubbink DT, Vermeulen H, Goossens A, Kelner RB, Schreuder SM, Lubbers MJ (2008) Occlusive versus gauze dressings for local wound care in surgical patients: a randomized clinical trial. Arch Surg 143:950–955. doi:10.1001/archsurg.143.10.950
Zadeh Farahani RM, Shahidi A (2009) Occlusive dressing of wounds: old tradition, new concepts. J Tissue Viability 18:57–58. doi:10.1016/j.jtv.2008.11.005
Mir MC, Takagi T, Campbell RA, Sharma N, Remer EM, Li J, Demirjian S, Stein R, Kaouk J, Campbell SC (2014) Poorly functioning kidneys recover from ischemia after partial nephrectomy as well as strongly functioning kidneys. J Urol 192:665–670. doi:10.1016/j.juro.2014.03.036
Meeks JJ, Zhao LC, Navai N, Perry KT Jr, Nadler RB, Smith ND (2008) Risk factors and management of urine leaks after partial nephrectomy. J Urol 180:2375–2378. doi:10.1016/j.juro.2008.08.018
Robb I (1890) On drainage in pelvic abdominal surgery. Ann Sur 12:425–432
Abramson DJ (1976) Charles Bingham Penrose and the Penrose drain. Sur Gynecol Obstet 143:285–286
Romm S (1982) The persons behind the name: Charles Bingham Penrose. Plast Reconstr Surg 70:397–399
Cerise EJ, Pierce WA, Diamond DL (1970) Abdominal drains: their role as a source of infection following splenectomy. Ann Surg 171:764–769
Diez JA, Pujato MR, Ferreres AR (1990) The need of drainage after cholecystectomy. HPB Surg 3:5–9 (discussion 9–10)
Godoy G, Katz DJ, Adamy A, Jamal JE, Bernstein M, Russo P (2011) Routine drain placement after partial nephrectomy is not always necessary. J Urol 186:411–415. doi:10.1016/j.juro.2011.03.151
Acknowledgments
The authors thank Dr. Masayoshi Okumi, Department of Urology, Tokyo Women’s Medical University, for helpful discussions. We also thank Ms. Nobuko Hata for arranging the database.
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Tachibana, H., Iida, S., Kondo, T. et al. Possible impact of continuous drainage after minimally invasive partial nephrectomy. Int Urol Nephrol 47, 1763–1769 (2015). https://doi.org/10.1007/s11255-015-1094-x
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DOI: https://doi.org/10.1007/s11255-015-1094-x