Abstract

Research Article

Electrocoagulation with greased lidocaine gel 2% as hemostatic maneuver after minimally invasive partial nephrectomy: Experimental and preliminary clinical results

Marcos Tobias-Machado*, Vinicius JA Panico, Lucila H Simardi, Eliney F Faria, Rene Sotelo, Ruben Suarez, Diego Abreu, Andre Meirelles, Edison Schneider and Hamilton C Zampolli

Published: 29 April, 2020 | Volume 4 - Issue 1 | Pages: 019-023

Methods: Experimental phase: Performed a partial nephrectomy off clamp in pig model followed by cauterization of lidocaine gel 2% with different power (control, 30W, 50W and 100W) in the kidney resection bed to evaluate efficacy and deep injury extension.

Clinical phase: 20 patients submitted to laparoscopic or partial nephrectomy for low risk RENAL score were utilized greased lidocaine gel 2% with 50W in cautery scalpel to hemostasis of renal parenchima to validate efficacy and safety.

Results: Experimental study shows that this technique is effective and promote better hemostasis with 50W and 100W, with deep injury of less than 3 mm.

Clinical study confirm efficacy, good control of hemorrage, few complications and no transfusion. Minimal changes in hematocrit, haemoglobin and creatinine were observed.

Conclusion: In this preliminary experience the use of this new alternative to hemostasis for low risk partial nephrectomy was satisfactory and with good intra and postoperative results.

The best advantages were safety in terms of the depth thermal injury, low cost and absence of artifacts over the resection area observed at CT scan postoperatively.

Read Full Article HTML DOI: 10.29328/journal.acst.1001017 Cite this Article Read Full Article PDF

References

  1. Chen DYT, Uzzo RG. Optimal management of localized renal cell carcinoma: surgery, ablation, or active surveillance. J Natl Compr Canc Netw. 2009; 7: 635–642. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19555585
  2. Kunath F, Schmidt S, Krabbe L-M, Miernik A, Dahm P, et al. Partial nephrectomy versus radical nephrectomy for clinical localised renal masses. Cochrane Database Syst Rev. 2017; 5: CD012045. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28485814
  3. Russo P. End stage and chronic kidney disease: associations with renal cancer. Front Oncol. 2012; 2: 28. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22649783
  4. Kara O, Maurice MJ, Malkoc E, Ramirez D, Nelson RJ, et al. Comparison of robot-assisted and open partial nephrectomy for completely endophytic renal tumours: a single centre experience. BJU Int. 2016; 118: 946–951. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27477777
  5. Kutikov A, Uzzo RG. The R.E.N.A.L. nephrometry score: a comprehensive standardized system for quantitating renal tumor size, location and depth. J Urol. 2009; 182: 844–853. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/19616235
  6. Rossaint R, Bouillon B, Cerny V, Coats TJ, Duranteau J, et al. Management of bleeding following major trauma: an updated European guideline. Crit Care. 2010; 14: R52. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20370902
  7. Metro MJ, McAninch JW. Surgical exploration of the injured kidney: current indications and techniques. Int Braz J Urol. 2003; 29: 98–105. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15745491
  8. Rosales A, Salvador J, De Graeve N, Angerri O, Villavicencio H. Clamping of the renal artery in laparoscopic partial nephrectomy: an old device for a new technique. Eur Urol. 2005; 47: 98–101. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/15582256
  9. Abarzua-Cabezas FG, Sverrisson E, De La Cruz R, Spiess PE, Haddock P, et al. Oncological and functional outcomes of salvage renal surgery following failed primary intervention for renal cell carcinoma. Int Braz J Urol. 2015; 41: 147–154. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/25928521
  10. Tanagho YS, Bhayani SB, Figenshau RS. Robot-assisted partial nephrectomy in contemporary practice. Front Oncol. 2012; 2: 213. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23336101
  11. Larcher A, Sun M, Dell’Oglio P, Trudeau V, Boehm K, et al. Mortality, morbidity and healthcare expenditures after local tumour ablation or partial nephrectomy for T1A kidney cancer. Eur J Surg Oncol. 2017; 43: 815–822. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/27692535
  12. Tsui KH, van Ophoven A, Shvarts O, Belldegrun A. Nephron-sparing surgery for renal cell carcinoma. Rev Urol. 1999; 1: 216–225. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16985800
  13. de Matos Filho AS, Petroianu A, Alberti LR, Vidigal PVT, dos Reis DCF, de Souza DM. Liver hemostasis using a dry electrocautery or greased with lidocaine or neomycin or glycerin or vaseline, in rabbit. Rev Col Bras Cir. 2009; 36: 442–448. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/20069158
  14. Petroianu A. Hemostasis of the liver, spleen, and bone achieved by electrocautery greased with lidocaine gel. Surg Today. 2011; 41: 300–302. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/21264774

Figures:

Figure 1

Figure 1

Figure 1

Figure 2

Figure 1

Figure 3

Figure 1

Figure 4

Similar Articles

Recently Viewed

Read More

Most Viewed

Read More

Help ?