Secure Reconstruction Technique after Partial Nephrectomy Irrespective of Tumor Size and Location

Introduction: Nephron-sparing surgery for large renal masses is not considered a safe procedure because of high com®) and Hem-O-Lok® ® masses. Materials and Methods: ® ® and Hem-O-Lok® Results: Conclusions: ® ® and Hem-O-Lok® combination was safe


INTRODUCTION
has evolved in recent years with a trend toward parenchymal-sparing and minimally invasive approaches.
mon and appropriate treatment for patients with small -Clinical Urology Clinical Urology requires proper techniques.Despite various surgical techniques to prevent postoperative adverse events nephrectomy require further special secure techniques to prevent adverse events that should be comfortable to both surgeons and patients.Secure reconstruction technique is particularly needed in high risk patient surgeons have become more comfortable with the improved renal imaging and the increased detection of small incidental masses have allowed widespread application of laparoscopy in renal cancer surgery.
satisfactory caliceal and renal parenchymal repair.
of cinching the suture down on the renal parenchyma is limited in traditional methods of closing the parenchymal defect because of the "cheese slicing" effect of developed several techniques to enhance coaptation strength using exogenous material or clip.Lapra-ty or weck clip are currently used.Clip should be absorbable when it is used to over seal collecting system the size and location of the defect.

MATERIALS AND METHODS
Retrospective data analysis was performed under the approval of the Institutional Review  follow-up evaluation.Our reconstruction technique did not require ureteral stent or catheter indwelling cell carcinoma patients from group 2 had metastatic lesions at liver at postoperative follow-up period.One -    preserved the remaining renal parenchyma without keeping the "fragile" renal parenchyma safe from inwith mono-material group could be explained in two tempts for needle passing because cinching was obmono-material method required at least 2-fold more attempts due to the vertical mattress suture method.
the combined method because Hem-O-Lok ® offers material method delivers upward or downward forces perpendicular to the capsular surface.
tomy is comparable to radical nephrectomy.Since no difference between survival rates in patients who underwent radical nephrectomy and nephron sparing Similar long-term outcome would be exthe primary determinant of outcome.

CONCLUSION
Nephron-sparing surgery using expanded ® ) alone or a ® and Hem-O-Lok ® ® Clip) combination was relatively safe without other additional combined method afforded easier handling and less operation time than the mono-material method.No function occurred with either of the procedures.

EDITORIAL COMMENT
considered the best alternative in treatment of renal the comparable oncological outcomes to the stan-evance after several studies that demonstrate higher risk of develop chronic renal failure after radical ® clips on the sutures allows a more even distribution of the tension applied on the renal surface with a consequent better coaptation.Studies developed in our laboratory have shown that the tension that can be applied on the patimes higher than the achieved with traditional knot tying.Maintaining the placed stitches perpendicular to the capsule when tightening aid-avoiding tears.
if needed to achieve an optimal hemostasis.to the vertical mattress suture line to prevent parenchymal tears is an interesting addition to the open even distribution of tension.Its use could gain relrenal capsule has been damaged or when clips are not of these advances could be the explanation for the represented in the almost non-existent complications reported in the paper.and single-surgeon experience are present in this and many other studies.A randomized prospective study comparing this new approach to the traditional partial nephrectomy technique using a knot-tying reconstruction could be a valuable addition to establish differences.
despite of living in a minimally invasive surgery of excellence in the armamentarium of urologists to this classical technique will always be welcome.

Figure 1 -
Figure1-Mono-material method (Gore-tex ® only).A) The renal tumor was resected with a 1 cm margin.B) The exposed collecting system and vessels were repaired.C) Both ends of the resection margin were sutured with prepared 2-0 absorbable suture materials, of bilateral angiomyolipoma and none of solitary kidney.Several presenting locations and ethylene and Hem-O-Lok ® ing strict hemostasis of the surgical bed during surgery.delayed bleeding which required blood transfusion.

Figure 3 -
Figure 3 -Firm renal parenchyma after the combination-material method.

Figure 4 -
Figure 4 -Preoperative (upper) and postoperative (lower) CT or MR images of various tumor locations and shapes.A) Left renal upper pole mass and intraparechymal type presentation.B) Right renal midportion mass.C) Left renal lower pole mass.D) Left renal hilar mass.
of nephron sparing surgery for localized renal cell car-roscopic wedge resection and partial nephrectomy--the Washington University experience and review of the -Laparoscopic partial nephrectomy with suture repair of tissue sealant during laparoscopic partial nephrectomy.laparoscopically performed partial nephrectomy us-scopic and open partial nephrectomies for single renal have been reported with the aim of part in this trend and presents a well-documented initial experience using a novel technique for open be useful in the management of larger and complex located tumors.described laparoscopic renorrhaphy techniques based providing a reliable and reproducible reconstruction.

Table 1 -
Demographic and perioperative data.