Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience)
Abstract. Background:. Nephron sparing surgery is a well-established surgical procedure for patients with small/bilateral renal masses. During the procedure, hilar control can be achieved by using bulldog clamps individually on the renal vessels, the renal artery alone without clamping the vein, or...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Health
2021-09-01
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| Series: | Current Urology |
| Online Access: | http://journals.lww.com/10.1097/CU9.0000000000000022 |
| _version_ | 1798025708425969664 |
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| author | Abdul Rouf Khawaja Shayesta Ali Yasir Dar Malik Abdul Rouf Khalid Sofi Sajad Malik Arif Hamid Bhat Mohd Saleem Wani |
| author_facet | Abdul Rouf Khawaja Shayesta Ali Yasir Dar Malik Abdul Rouf Khalid Sofi Sajad Malik Arif Hamid Bhat Mohd Saleem Wani |
| author_sort | Abdul Rouf Khawaja |
| collection | DOAJ |
| description | Abstract. Background:. Nephron sparing surgery is a well-established surgical procedure for patients with small/bilateral renal masses. During the procedure, hilar control can be achieved by using bulldog clamps individually on the renal vessels, the renal artery alone without clamping the vein, or a laparoscopic Satinsky clamp for en bloc hilar clamping. In our series, we described the outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control.
Materials and methods:. All eligible cases with confirmed diagnosis of a renal mass were advised of nephron sparing surgery. The short-term outcomes were evaluated by warm ischemia time (using a Satinsky clamp especially when CT renal angiography was not available), average blood loss, and length of postoperative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen, local recurrence, and distant metastasis.
Results:. Of 30 cases 20 were male. The mean age was 54.25 years. On preoperative evaluation, 24 cases were T1a stage and the rest were 6 T1b stage. Four tumors were located in the upper pole, 4 in the posterior midpole, and 22 in the lower pole. Twenty-six patients had a low complexity score on RENAL scoring (ie, 4–6) and 4 patients a medium complexity score (ie, 7–9). Three patients were converted to open partial nephrectomy because of technical difficulty in intracorporeal suturing and difficulty in achieving hemostasis. Among these 3 patients, 2 patients had posterior base tumors and 1 had a lower polar tumor. Average blood loss was 350 ml, warm ischemia time was 28.46 minutes, and postoperative stay was 4.55 days. Of 30 specimens for histopathology, 23 (76%) were clear cell renal cell carcinoma (RCC), 4 (13%) were papillary RCC, 1 (3.3%) was chromophobe RCC, whereas 2 (6.6%) were benign (oncocytoma). Margins were free of tumors in all the patients with no recurrence in 2 years of follow-up.
Conclusion:. Laparoscopic partial nephrectomy by using a Satinsky clamp as a tool for en bloc hilar clamping in the proper axis at the hilum takes care of multiple vessels irrespective of size and number, particularly when renal angiography is not available. This technique of en bloc hilar clamping is quite useful especially in developing countries where robotic facilities are not available. The Satinsky clamp decreases blood loss and intraoperative time. |
| first_indexed | 2024-04-11T18:23:12Z |
| format | Article |
| id | doaj.art-6b291f3d354c47da9bf4914ccde730f3 |
| institution | Directory Open Access Journal |
| issn | 1661-7649 1661-7657 |
| language | English |
| last_indexed | 2024-04-11T18:23:12Z |
| publishDate | 2021-09-01 |
| publisher | Wolters Kluwer Health |
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| series | Current Urology |
| spelling | doaj.art-6b291f3d354c47da9bf4914ccde730f32022-12-22T04:09:42ZengWolters Kluwer HealthCurrent Urology1661-76491661-76572021-09-0115317217510.1097/CU9.0000000000000022202109000-00009Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience)Abdul Rouf Khawaja0Shayesta Ali1Yasir Dar2Malik Abdul Rouf3Khalid Sofi4Sajad Malik5Arif Hamid Bhat6Mohd Saleem Wani7Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaDepartment of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaDepartment of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaDepartment of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaDepartment of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaDepartment of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaDepartment of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaDepartment of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, IndiaAbstract. Background:. Nephron sparing surgery is a well-established surgical procedure for patients with small/bilateral renal masses. During the procedure, hilar control can be achieved by using bulldog clamps individually on the renal vessels, the renal artery alone without clamping the vein, or a laparoscopic Satinsky clamp for en bloc hilar clamping. In our series, we described the outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control. Materials and methods:. All eligible cases with confirmed diagnosis of a renal mass were advised of nephron sparing surgery. The short-term outcomes were evaluated by warm ischemia time (using a Satinsky clamp especially when CT renal angiography was not available), average blood loss, and length of postoperative hospital stay. The oncological outcome was evaluated by noting the surgical margins of histopathological specimen, local recurrence, and distant metastasis. Results:. Of 30 cases 20 were male. The mean age was 54.25 years. On preoperative evaluation, 24 cases were T1a stage and the rest were 6 T1b stage. Four tumors were located in the upper pole, 4 in the posterior midpole, and 22 in the lower pole. Twenty-six patients had a low complexity score on RENAL scoring (ie, 4–6) and 4 patients a medium complexity score (ie, 7–9). Three patients were converted to open partial nephrectomy because of technical difficulty in intracorporeal suturing and difficulty in achieving hemostasis. Among these 3 patients, 2 patients had posterior base tumors and 1 had a lower polar tumor. Average blood loss was 350 ml, warm ischemia time was 28.46 minutes, and postoperative stay was 4.55 days. Of 30 specimens for histopathology, 23 (76%) were clear cell renal cell carcinoma (RCC), 4 (13%) were papillary RCC, 1 (3.3%) was chromophobe RCC, whereas 2 (6.6%) were benign (oncocytoma). Margins were free of tumors in all the patients with no recurrence in 2 years of follow-up. Conclusion:. Laparoscopic partial nephrectomy by using a Satinsky clamp as a tool for en bloc hilar clamping in the proper axis at the hilum takes care of multiple vessels irrespective of size and number, particularly when renal angiography is not available. This technique of en bloc hilar clamping is quite useful especially in developing countries where robotic facilities are not available. The Satinsky clamp decreases blood loss and intraoperative time.http://journals.lww.com/10.1097/CU9.0000000000000022 |
| spellingShingle | Abdul Rouf Khawaja Shayesta Ali Yasir Dar Malik Abdul Rouf Khalid Sofi Sajad Malik Arif Hamid Bhat Mohd Saleem Wani Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience) Current Urology |
| title | Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience) |
| title_full | Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience) |
| title_fullStr | Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience) |
| title_full_unstemmed | Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience) |
| title_short | Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience) |
| title_sort | outcome of laparoscopic nephron sparing surgery using a satinsky clamp for hilar control a trusted tool skims experience |
| url | http://journals.lww.com/10.1097/CU9.0000000000000022 |
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