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Outcome of laparoscopic nephron sparing surgery using a Satinsky clamp for hilar control: a trusted tool (SKIMS experience).
Khawaja, Abdul Rouf; Ali, Shayesta; Dar, Yasir; Rouf, Malik Abdul; Sofi, Khalid; Malik, Sajad; Bhat, Arif Hamid; Wani, Mohd Saleem.
Afiliación
  • Khawaja AR; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
  • Ali S; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
  • Dar Y; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
  • Rouf MA; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
  • Sofi K; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
  • Malik S; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
  • Bhat AH; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
  • Wani MS; Department of Urology, Sheri Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu and Kashmir, India.
Curr Urol ; 15(3): 172-175, 2021 Sep.
Article en En | MEDLINE | ID: mdl-34552458
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.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Curr Urol Año: 2021 Tipo del documento: Article País de afiliación: India Pais de publicación: Estados Unidos

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Idioma: En Revista: Curr Urol Año: 2021 Tipo del documento: Article País de afiliación: India Pais de publicación: Estados Unidos