Analysis of 10 cases of posterior laparoscopic rapid suture method partial nephrectomy
Cancer Hospital of Zhengzhou University
Feng Chaojie Zhao Shiming Hou Guodong He Chaohong Ren Junkai He Chaohong, Department of Urology, Henan Cancer Hospital
OBJECTIVE: To investigate the feasibility and effectiveness of rapid suture in the application of posterior laparoscopic kidney unit preservation surgery for early kidney cancer with limited and maximum diameter less than 4 cm.
METHODS: We retrospectively analyzed the clinical data of 10 patients with early-stage renal cancer who underwent posterior laparoscopic renal unit preservation surgery with rapid suturing from April 2012 to June 2013. All patients were treated with partial nephrectomy by posterior laparoscopic rapid suture method, which was fully prepared before blocking the renal artery, intercepted with needle 0/1 absorbable suture about 15 cm, knotted at 3 cm from the caudal end, Hem-O-lock was clamped at the proximal end of the knot, sutured into hemostatic gauze, and 2-3 sutures were made according to the size of the tumor in the same method to block the renal artery and remove the tumor. “Eight” sutures are made to close the incisional margin of the kidney, tighten the sutures, Hem-O-lock is clamped at the proximal end of the knot, and if necessary, it can be further fixed with titanium clamps, without cutting the thread and tying the knot, the same method is made to completely close the incisional margin of the kidney, open the renal artery, observe whether there is bleeding at the traumatic margin of the kidney, if there is bleeding, continue to apply sutures to tighten the knot, or at the distal end of the sutures If there was bleeding, the suture could be tightened and knotted, or the distal end of the suture could be tightened and Hem-O-lock clamped to stop the bleeding completely.
RESULTS: All 10 patients were successfully treated with retroperitoneoscopic surgery without intermediate opening, 8 cases of postoperative pathology clear cell carcinoma, 1 case of renal eosinophilic tumor, and 1 case of malignant tumor, all patients underwent successful partial nephrectomy, no intermediate radical nephrectomy, the average operating time was 140 min, the average blood loss was 150 ml, the average intraoperative renal artery block was 8-22 min, and the average was 12 min. The average follow-up time was 10.5 months, with no local recurrence of tumor and no patients with surgery-related renal insufficiency.
Conclusion: Posterior laparoscopic surgery to preserve the renal unit is a safe and effective treatment method for limited early renal cancer with a maximum diameter of less than 4 cm, and has been widely used in clinical practice, but laparoscopic surgery has a long learning period and high technical requirements, especially the laparoscopic suture tying technique is more difficult for beginners to master. It can be used as a better method in clinical practice for both beginners and skilled patients.
Keywords: posterior laparoscopy, rapid suturing, partial nephrectomy