Secure reconstruction technique after partial nephrectomy irrespective of tumor size and location

• Published in: International Brazilian journal of urology Vol. 35; no. 4; pp. 416 - 426
• Main Authors: Park, Dong Soo, Jang, Woong Ki
• Format: Journal Article
• Language: English
• Published: Brazil Sociedade Brasileira de Urologia 01.08.2009
• Subjects: Aged; Aged, 80 and over; Angiomyolipoma - surgery; carcinoma; Carcinoma, Renal Cell - surgery; Hemostasis, Surgical - instrumentation; Humans; Kidney Neoplasms - surgery; Magnetic Resonance Imaging; nephrectomy; Nephrectomy - methods; Nephrons - surgery; partial; Polytetrafluoroethylene - therapeutic use; renal cell; Retrospective Studies; surgical technique; Tomography, X-Ray Computed; Treatment Outcome
• ISSN: 1677-5538; 1677-6119; 1677-5538
• DOI: 10.1590/S1677-55382009000400004

Nephron-sparing surgery for large renal masses is not considered a safe procedure because of high complication rate. We present our experience using expanded polytetrafluoroethylene (Gore-Tex) and Hem-O-Lok (Weck Clip) as hemostatic agents during open partial nephrectomy (OPN) to perform nephron-sparing surgery for large renal masses. Sixty patients underwent OPN for suspicious renal cell carcinomas. Thirty-four patients with tumors < 2.5 cm in size underwent OPN with Gore-Tex alone (group 1). Clinical data from a computerized database were reviewed and compared to a contemporary group of 26 patients with tumors >or= 2.5 cm in size who underwent OPN with Gore-Tex and Hem-O-Lok (group 2). The mean patient age was 53 years (range, 35-85 years), and the mean duration of follow-up was 41.8 months (range, 6-56 months). The mean cold ischemic times were 24.0 minutes (range, 12-37 minutes) and 35.3 minutes (range, 18-65 minutes) respectively in group 1 and 2. The tumor sizes in groups 1 and 2 were 1.7 +/- 0.4 cm and 4.74 +/- 2.75 cm, respectively. No major complications, such as urine leakage or delayed bleeding, were noted in either group. Nephron-sparing surgery using Gore-Tex alone or a Gore-Tex and Hem-O-Lok combination was safe without high-priced hemostatic agents because the tensile strength was sufficient to maintain firmness in the repaired parenchyma. In addition, the procedure is easy to perform and takes less time to complete. Furthermore, major complications, recurrence, and impaired renal function did not occur with this procedure.