Laparoscopic partial nephrectomy: six degrees of haemostasis

• Published in: BJU international Vol. 107; no. 9; pp. 1454 - 1459
• Main Authors: Louie, Michael K., Deane, Leslie A., Kaplan, Adam G., Lee, Hak J., Box, Geoffrey N., Abraham, Jose Benito A., Borin, James F., Khan, Farhan, McDougall, Elspeth M., Clayman, Ralph V.
• Format: Journal Article
• Language: English
• Published: Oxford, UK Blackwell Publishing Ltd 01.05.2011; Wiley-Blackwell
• Subjects: Adult; Aged; Biological and medical sciences; Female; Hemostasis; Humans; Kidney Neoplasms - surgery; laparoscopic partial nephrectomy; Laparoscopy; Male; Medical sciences; Middle Aged; Nephrectomy - methods; Nephrology. Urinary tract diseases; Nephrons - surgery; nephron‐sparing surgery; partial nephrectomy; Reproducibility of Results; Retrospective Studies; Treatment Outcome; Young Adult; Endoscopic surgery; Nephrology; Laparoscopy; partial nephrectomy; Urology; Conservative surgery; Treatment; nephron-sparing surgery; Nephrectomy; Partial; Hemostasis; Nephron; Endoscopy; laparoscopic partial nephrectomy
• ISSN: 1464-4096; 1464-410X; 1464-410X
• DOI: 10.1111/j.1464-410X.2010.09651.x

Study Type – Therapy (case series) 
Level of Evidence 4 What’s known on the subject? and What does the study add? Laparoscopic partial nephrectomy is a technically challenging procedure that many urologists do not perform due to the possibility of excess bleeding, increased warm ischemia of the kidney, and difficulty with laparoscopic suturing. This study analyzes one method of laparoscopic partial nephrectomy that allows a surgeon increased confidence of haemostasis and urinary tract closure while maintaining a short warm ischemia time. OBJECTIVE • To describe six steps for haemostasis and collecting system closure (‘six degrees of haemostasis’) that are reproducible and that minimize the two most concerning complications of laparoscopic partial nephrectomy: haemorrhage and urine leakage. METHODS • A retrospective study of 23 consecutive laparoscopic partial nephrectomy cases performed by a single surgeon between 2005 and 2008 using the ‘six degrees of haemostasis’ was carried out. RESULTS • There were no cases of intraoperative, postoperative or delayed bleeding. • There were no cases of urine leakage. CONCLUSION • The ‘six degrees of haemostasis’ technique for laparoscopic partial nephrectomy described in the present study provides a reliable and reproducible method to reassure the surgeon of haemostasis and provide a decreased risk of urine leakage.