Reconstruction: Outcomes & Complications
Moderated Poster Session
MP14-16 - Is the two layer Closure Necessary in Robotic Partial Nephrectomy
Saturday, September 22
10:00 AM - 12:00 PM
Location: Room 241
Introduction & Objective : Warm ischemia time (WIT) has been a concern in robotic partial nephrectomy (RPN). Multiple maneuvers have been tried to reduce WIT, like Clampless RPN, early unclapmping, and using of Laser. Closing the collecting system is time consuming the first step in renorrhaphy and there has been always concern about urine leak after RPN. We mass closed the renal parachyma without dedicated closure of the collecting system to reduce the warm ischemia time and speed the renorrhaphy. We report our own experience in omiting the closure of the collecting system.
Methods : A total of 335 patient underwent RPN at our institute by single surgeon. RPN was utilized routinely in the treatment of small renal masses (<4 cm) and selectively in the treatment in larger mass (4-7 cm) at our institute. RCC was the final diagnosis of 269 patients (% 80.2). All patients but two (0.74 %) had negative margin at the initial surgery. We did not specifically close the collecting system in or last 225 cases to spead the renorrhaphy. We left Jackson Pratt at the endo of the renorrhaphy to detect any urine leak and sent the drainage fluid for analysis.
Results : The avarage patients age was 67 (ranging form 28 -79)). The avarage WIT was 14 min (5-19) which was significantly shorter that the earlier cases where we closed the collecting system separately as it was 19 min ( 14- 34) (P<0.05). Avarage blood loss was 195 ml (50-400). The avarage JP output in the first 24 hrs after surgery was 40 (10-200). The change of the creatinine was 0.2 (0-0.8), compared to 0.5 (0.2-2) in the earlier cases (P<0.05). None of the patients experienced urine leak or dealyed bleeding as per the creatinine of the drainge fluid and the blood hemoglobin. WIT was maintained below 20 min in all the cases.
Conclusions : Omitting the closure of the collecting system speed the renorrhaphy and decreases WIT and creatinine changes after surgery. No adverse event were incountered due to adoption of this tecknique.