Robotik parsiyel nefrektomide renorafi için geleneksel poliglaktin ile dikenli dikiş materyallerinin karşılaştırılması

Amaç: Robotik parsiyel nefrektomi RPN esnasında renorafide geleneksel emilebilen dikiş materyalleri ile dikenli dikiş materyalleri kullanımının cerrahi sonuçlar üzerine etkisini değerlendirmek.Gereç ve Yöntemler: 2009 ve 2011 yılları arasında böbrekte kitle sebebiyle RPN yapılan 38 hasta çalışmaya dahil edildi. Bu 38 hastanın 16’sında renorafi poliglaktin Grup 1 ve 22’sinde ise dikenli poliglikonat dikiş materyali Grup 2 ile yapıldı. Gruplar arasında ortalama operasyon süresi, tahmini kan kaybı, sıcak iskemi süresi, hastanede kalış süresi, komplikasyonlar ve onkolojik sonuçlar prospektif olarak değerlendirildi. Bulgular: Gruplar arasında yaş, cinsiyet, komorbidite ve tümör karakteristikleri açısından istatistiksel olarak anlamlı farklılık izlenmedi. Ortalama operasyon süresi Grup 1’de 163±55 dakika iken Grup 2’de 137±18 dakika idi p=0,001 . Tahmini kan kaybı Grup 1’de 472±540 mil. iken Grup 2’de 185±110 mil. idi p=0,001 . Ortalama hematokrit düşüşü Grup 1’de %6,43±3,4 iken Grup 2’de %3,82±2,7 idi p=0,015 . Sıcak iskemi süresi Grup 1’de ortalama 28.7±9.3 dakika iken, Grup 2’de ortalama 20,9±6,9 dakika idi p=0,001 . Ortalama takip süresi gruplar arasında sırasıyla 24 ve 18 aydı. Takip süresince her iki grupta da tümör rekürrensine rastlanılmadı.Sonuç: Robotik parsiyel nefrektomide renorafi için dikenli sütür materyallerinin kullanımı böbrek parankim onarımının hızlı, güvenli ve kuvvetli yapılmasını kolaylaştırmaktadır. Böbrek parankim onarımının dikenli dikiş materyalleri ile yapılması sıcak iskemi süresini ve tahmini kan kaybını azaltmaktadır

Anahtar Kelimeler:

Böbrek, kanser, robot, parsiyel nefrektomi

Comparison of barbed and conventional polyglactin sutures for renorraphy in robot assisted partial nephrectomy

Objective: To evaluate the effect of the barbed and the conventional absorbable sutures for renorraphy on the outcomes of robot assisted partial nephrectomy RAPN .Material and Methods: Between 2009 and 2011, a total 38 patients with a renal mass who underwent RAPN were included in this study. Of 38, renorraphy was performed with a polyglactin suture in 16 patients Group 1 and, with a barbed polyglyconate suture in 22 patients Group 2 . The mean operative time, estimated blood loss EBL , warm ischemia time WIT , hospital stay, complications and oncologic outcomes were evaluated prospectively.Results: There was no statistical difference between groups in terms of age, gender, comorbidities and tumor characteristics. The mean operative time was 163± 55 min in Group 1 and 137 ± 18 min Group 2 p=0,001 . The mean EBL was 472 ± 540 ml in Group 1 and 185± 110 ml in Group 2 p=0,001 . The mean decline in hematocrit was %6.43 ± 3.4 in Group 1 and %3.82 ± 2.7 in Group 2 p=0.015 . The WIT was 28.7 ± 9.3 min and 20.9 ± 6.9 min p=0.005 in Group 1 and 2, respectively. The mean follow up was 24 and 18 months in Group 1 and 2, respectively. No tumor recurrence has occurred in both groups at the follow-up.Conclusions: Utilization of barbed sutures for renorraphy during RAPN facilitates rapid, safe and potent renal parenchymal repair. Renorraphy with barbed suture results in reduced warm ischemia time and blood loss

Keywords:

kidney, cancer, robot, partial nephrectomy,

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Hollingsworth JM, Miller DC, Dunn RL, Montgomery JS, Roberts WW, Hafez KS, et al. Surgical management of low- stage renal cell carcinoma: Technology does not supersede biology. Urology 2006;67:1175-80.
Shuch B, Lam JS, Belldegrun AS. Open partial nephrec- tomy for the treatment of renal cell carcinoma. Curr Urol Rep 2006;7:31-38.
Novick AC, Campbell SC, Belldegrun AS, Blute ML, Chow GK, Derweesh IH, et al. Guidelines for management of the clinical stage 1 renal mass; in Novick AC, Campbell SC (eds): American Urological Association Education and Research (AUA) Guidelines. http://www.auanet.org, AUA, 2009, 2012
Thompson RH, Kaag M, Vickers A, Kundu S, Bernstein M, Lowrance W, et al. Contemporary use of partial nephrec- tomy at a tertiary care center in the united states. J Urol 2009;181:993-97.
Weight CJ, Larson BT, Gao T, Campbell SC, Lane BR, Ka- ouk JH, et al. Elective partial nephrectomy in patients with clinical t1b renal tumors is associated with improved ove- rall survival. Urology 2010;76:631-37.
Weight CJ, Lieser G, Larson BT, Gao T, Lane BR, Campbell SC, et al. Partial nephrectomy is associated with improved overall survival compared to radical nephrectomy in pa- tients with unanticipated benign renal tumours. Eur Urol 2010;58:293-98.
Thompson RH, Siddiqui S, Lohse CM, Leibovich BC, Rus- so P, Blute ML. Partial versus radical nephrectomy for 4 to 7 cm renal cortical tumors. J Urol 2009;182:2601-06.
Benway BM, Bhayani SB, Rogers CG, Dulabon LM, Patel MN, Lipkin M, et al. Robot assisted partial nephrectomy versus laparoscopic partial nephrectomy for renal tumors: A multi-institutional analysis of perioperative outcomes. J Urol 2009;182:866-72.
Dulabon LM, Kaouk JH, Haber GP, Berkman DS, Rogers CG, Petros F, et al. Multi-institutional analysis of robotic partial nephrectomy for hilar versus nonhilar lesions in 446 consecutive cases. Eur Urol 2011;59:325-30.
Edge SB, Compton CC. The american joint committee on cancer: The 7th edition of the ajcc cancer staging ma- nual and the future of tnm. Annals of surgical oncology 2010;17:1471-74.
Kutikov A, Uzzo RG. The R.E.N.A.L. Nephrometry score: A comprehensive standardized system for quantitating re- nal tumor size, location and depth. J Urol 2009;182:844-53.
Dindo D, Demartines N, Clavien PA. Classification of sur- gical complications: A new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004;240:205-13.
Steffens J, Humke U, Ziegler M, Siemer S. Partial nephrec- tomy with perfusion cooling for imperative indications: A 24-year experience. BJU Int 2005;96:608-11.
Tatsugami K, Eto M, Yokomizo A, Kuroiwa K, Inokuchi J, Tada Y, et al. Impact of cold and warm ischemia on pos- toperative recovery of affected renal function after parti- al nephrectomy. J Endourol 2011;25:869-873; discussion 873-4.
Marley CS, Siegrist T, Kurta J, O’Brien F, Bernstein M, So- lomon S, et al. Cold intravascular organ perfusion for renal hypothermia during laparoscopic partial nephrectomy. J Urol 2011;185:2191-95.
Gettman MT, Blute ML, Chow GK, Neururer R, Bartsch G, Peschel R. Robotic-assisted laparoscopic partial neph- rectomy: Technique and initial clinical experience with Davinci robotic system. Urology 2004;64:914-18.
Gill IS, Kamoi K, Aron M, Desai MM. 800 laparoscopic partial nephrectomies: A single surgeon series. J Urol 2010;183:34-41.
Gill IS, Eisenberg MS, Aron M, Berger A, Ukimura O, Pa- til MB, et al. “Zero ischemia” partial nephrectomy: Novel laparoscopic and robotic technique. Eur Urol 2011;59:128- 34.
Viprakasit DP, Altamar HO, Miller NL, Herrell SD. Selecti- ve renal parenchymal clamping in robotic partial nephrec- tomy: Initial experience. Urology 2010;76:750-53.
White WM, Goel RK, Haber GP, Kaouk JH. Robotic par- tial nephrectomy without renal hilar occlusion. BJU Int 2010;105:1580-84.
Rais-Bahrami S, George AK, Herati AS, Srinivasan AK, Richstone L, Kavoussi LR. Off-clamp versus complete hilar control laparoscopic partial nephrectomy: Comparison by clinical stage. BJU Int 2012;109:1376-1381.
Kowalczyk KJ, Alemozaffar M, Hevelone ND, Ulmer WD, Plaster BA, Lipsitz SR, et al. Partial clamping of the renal artery during robot-assisted laparoscopic partial neph- rectomy: Technique and initial outcomes. J Endourol 2012;26:469-73.
Shikanov S, Wille M, Large M, Lifshitz DA, Zorn KC, Shalhav AL, et al. Knotless closure of the collecting system and renal parenchyma with a novel barbed suture during laparoscopic porcine partial nephrectomy. J Endourol 2009;23:1157-60.
Sammon J, Petros F, Sukumar S, Bhandari A, Kaul S, Me- non M, et al. Barbed suture for renorrhaphy during robot- assisted partial nephrectomy. J Endourol 2011;25:529-33.
Olweny EO, Park SK, Seideman CA, Best SL, Cadeddu JA. Self-retaining barbed suture for parenchymal repair during laparoscopic partial nephrectomy; initial clinical experience. BJU Int 2012;109:906-09.