Partial nephrectomy using a vascular sealing system.

Abstract

The margin resected at partial nephrectomy is so fragile that it is not easy to control bleeding. To control bleeding we developed a new technique using a vascular sealing system for hemostasis. A 38-year-old woman with renal cell carcinoma underwent partial nephrectomy. A tumor was identified in the lower pole of the left kidney. The kidney was exposed with the perinephric fat and the main renal artery was identified and clamped. Along the incision line the renal cortex was cut sharply to 10 to 15 mm. deep. A jaw of the vascular sealing system was carefully inserted into the sinus space between the renal pelvis and medulla. The jaws were gradually clamped together, and the renal medulla and vasculature were compressed and then sealed completely by computer controlled current. Because the renal pelvis was involved by tumor, the pelvis was removed partially with the tumor and approximated with absorbable sutures. Before reperfusion only a few additional sutures were needed for hemostasis. Warm ischemia time was 19 minutes. Our technique seems to be a promising method of rapidly achieving reliable hemostasis for partial nephrectomy.