Sutureless laparoscopic partial nephrectomy using fibrin gel reduces ischemia time while preserving renal function

  • Daniele Tiscione Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Tommaso Cai | ktommy@libero.it Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Lorenzo Giuseppe Luciani Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Marco Puglisi Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Daniele Mattevi Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.
  • Gabriella Nesi Division of Pathological Anatomy, University of Florence, Italy.
  • Mattia Barbareschi Division of Pathological Anatomy, Santa Chiara Regional Hospital, Trento, Italy.
  • Gianni Malossini Department of Urology, Santa Chiara Regional Hospital, Trento, Italy.

Abstract

Objectives: We evaluated the efficacy of sutureless laparoscopic partial nephrectomy (LPN), using a fibrin gel in order to minimize renal ischemia time and preserve kidney function.
Materials and Methods: Nineteen patients (mean age 58.3 ± 7.1) undergoing sutureless LPN using a fbrin gel were compared with a control group consisting of 21 patients (mean age 57.9 ± 7.5) subjected to LPN with standard suturing. Intraand post-operative data for the two groups were compared. The following parameters were recorded: patient demographics, Charlson Comorbidity Index, tumor characteristics according to the RENAL score, warm ischemia and operative times, estimated blood loss, mean hospital stay, post-operative complications referring to the Clavien-Dindo classification, renal function parameters pathologic and follow-up data. The main outcome measure was renal ischemia time and maintenance of kidney function.
Results: Median warm ischemia time was 13 minutes (range 11-19) in the group treated with fibrin gel and 19 (range 17- 29) in the control group, with a statistically significant difference (p < 0.001). The two groups were homogeneous in terms of the Charlson Comorbidity Index (4.6 vs 4.8) and RENAL score (9.6 vs 9.4). Median operative time differed significantly in the two groups, 183 minutes (range 145-218) in the group treated with fibrin gel and 201 (range 197-231) in the control group (p < 0.001). A negative surgical margin was reported in 18 patients (94.7%) in the group treated with fibrin gel and in 21 patients (100%) in the control group. No difference in renal function was found between the two groups.
Conclusions: Sutureless LPN with fibrin gel can reduce warm ischemia and total operative time while preserving kidney function.

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Published
2019-03-29
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Section
Original Papers - Oncology
Keywords:
Laparoscopic partial nephrectomy, renal cell carcinoma, haemostatic agent, fibrin sealant, complication
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How to Cite
Tiscione, D., Cai, T., Luciani, L., Puglisi, M., Mattevi, D., Nesi, G., Barbareschi, M., & Malossini, G. (2019). Sutureless laparoscopic partial nephrectomy using fibrin gel reduces ischemia time while preserving renal function. Archivio Italiano Di Urologia E Andrologia, 91(1), 30-34. https://doi.org/10.4081/aiua.2019.1.30

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