Discover all media in Laparoscopic Surgery on WeBSurg, The largest collection of educational programs in laparoscopic surgery
Authors & faculty members in Laparoscopic Surgery on WeBSurg
Our Editorial & scientific committee of WebSurg, the e-surgical reference.
Surgical Videos in Laparoscopic Surgery on WeBSurg
WebSurg, the e-surgical reference presents its range of videos.
Experts' Interviews in Laparoscopic Surgery on WeBSurg
WebSurg, the e-surgical reference presents its range of Experts' Interviews.
Operative techniques in Laparoscopic Surgery on WeBSurg
WebSurg, the e-surgical reference presents its range of Operative Techniques.
CME Center on WeBSurg
Online CME courses on WebSurg, the e-surgical reference in laparoscopic surgery.
IRCAD/EITS Lectures in Laparoscopic Surgery on WeBSurg
WebSurg, the e-surgical reference presents its range of Lectures.
Clinical cases in Laparoscopic Surgery on WeBSurg
WebSurg, the e-surgical reference in laparoscopic surgery presents its range of Clinical Cases.
WebSurg table of contents - all specialties, organs, pathologies, and topics in Laparoscopic Surgery
Mediastinal parathyroidectomy performed by videoassisted mediastinal surgery through an intercostal window (IVAMS)

Watch the videos

 Back to gallery

Tips And Tricks To Facilitate Renal Parenchymal Suturing During Laparoscopic Partial Nephrectomy

Original Case Presentations
View in high definition Video requirements
Mcdougall Elspeth,
University Of California, Irvine Medical Center,
Orange

PERSONAL COMMENTS:
Procedural Teaching Video

ABSTRACT:
Introduction & Objective: Laparoscopic partial nephrectomy is rapidly emerging as a potential surgical option for select renal tumors. The most challenging aspect of the procedure is the effective hemostatic closure of the collecting system and the renal parenchyma. We present our modification of Shalhav’s technique to limit warm ischemia time during closure of the collecting system and suturing of the bolster in position during laparoscopic partial nephrectomy. With this approach, there is no passage of needles into the abdomen and only two sutures are used.
Methods: This video demonstrates the use of the LapraTy (Ethicon Endosurgery, Inc., Cincinnati, OH) absorbable suture clips to quicken the time to suture the collecting system and secure the bolster during a laparoscopic upper pole heminephrectomy for renal tumor. Prior to initiating warm ischemia, 2 sutures are placed in the abdomen. A 10-inch length of 0-Vicryl on a CT-1 needle for suturing the bolster and a 6-inch length of 2-0 Vicryl on a SH needle for closure of the collecting system. Each suture has a LapraTy clip affixed on the end. After the hilar vessels have been clamped and excision of the tumor has been performed with a Ligasure device, the parenchymal surface is treated with the argon beam coagulator. Next, the collecting system is closed with the 6-inch suture; a layer of Floseal is applied. Then oxidized cellulose bolsters are placed into the renal parenchymal defect. Renorraphy is performed with the 10-inch suture and LapraTy clip. The needle is passed through one side of the edge of the incised renal parenchyma, over the bolster, and then out the opposite parenchymal edge. The suture is snugged down over the bolster and secured with 1 or 2 LapraTy clips. An additional LapraTy clip is placed ¼ inch from the last clip and the suture is cut between the two clips. The needle and suture with the LapraTy clip are now ready to repeat the suturing sequence to place another simple suture. A total of four sutures are placed in this manner, all with the same suture. As such, there is no passage of needles into the abdomen during warm ischemia.
Conclusion: This technique provides a rapid and effective hemostatic placement of the bolster during laparoscopic partial nephrectomy. To date, in ten procedures performed in this manner, there have been no complications of fistulae or bleeding.

Source of funding: Department of Urology, UCI (Research and Education Fund)
Laparobotic Approach to Pancreatoduodenectomy
Any questions? please contact us by email: