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Temporary Segmental Renal Artery Occlusion Using Reverse Phase Polymer for Bloodless Robotic Partial Nephrectomy

2009; Lippincott Williams & Wilkins; Volume: 182; Issue: 4 Linguagem: Inglês

10.1016/j.juro.2009.06.009

1527-3792

Alireza Moinzadeh, Sebastian Flacke, John A. Libertino, John Merhige, Jean-Marie Vogel, Katy Lyall, Curtis W. Bakal, Peter N. Madras,

Renal cell carcinoma treatment

No AccessJournal of UrologyInvestigative Urology1 Oct 2009Temporary Segmental Renal Artery Occlusion Using Reverse Phase Polymer for Bloodless Robotic Partial Nephrectomyis companion ofInitial Experience With Robot Assisted Partial Nephrectomy for Multiple Renal MassesGuideline for Management of the Clinical T1 Renal Mass Alireza Moinzadeh, Sebastian Flacke, John A. Libertino, John Merhige, Jean-Marie Vogel, Katy Lyall, Curtis W. Bakal, and Peter N. Madras Alireza MoinzadehAlireza Moinzadeh , Sebastian FlackeSebastian Flacke , John A. LibertinoJohn A. Libertino , John MerhigeJohn Merhige , Jean-Marie VogelJean-Marie Vogel , Katy LyallKaty Lyall , Curtis W. BakalCurtis W. Bakal , and Peter N. MadrasPeter N. Madras View All Author Informationhttps://doi.org/10.1016/j.juro.2009.06.009AboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract Purpose: Renal vascular clamping with ensuing warm ischemia is typically needed during robotic or laparoscopic partial nephrectomy. We developed a technique for angiographic delivery of the novel intra-arterial reverse thermoplastic polymer LeGoo-XL™ that allows temporary selective vascular occlusion with normal perfusion of the remaining kidney. Materials and Methods: Eight pigs underwent a total of 16 selective angiographic occlusions of the lower pole segmental artery using gel polymer. The technical feasibility of 2 hemostatic techniques, perfusion hemostasis and local plug formation, was assessed in 4 pigs each. Selective ischemia time was recorded and the vascular occlusion site was noted radiographically and laparoscopically. The feasibility of reversing the polymer from solid back to liquid state to allow reperfusion was determined. Pathological analysis of the kidney was completed in these acute model pigs. In the last 2 cases lower pole robotic partial nephrectomy was done using the da Vinci® surgical system. Results: Selective lower pole ischemia was achieved in all 8 cases. Perfusion hemostasis yielded an inconsistent duration of occlusion (zero to greater than 60 minutes). Vascular occlusion time using local plug formation was more reliable (17 to 30 minutes) with consistent ability to reverse the plug to liquid state by cold saline flush. Two lower pole robotic partial nephrectomies were completed with minimal blood loss. Conclusions: We developed a reliable technique of angiographic delivery of gel polymer for temporary vascular occlusion of selective renal artery branches using local plug formation. 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Google Scholar Lahey Clinic, Burlington and Pluromed, Inc., Woburn, Massachusetts, and Intuitive Surgical, Inc., Sunnyvale, California© 2009 by American Urological AssociationFiguresReferencesRelatedDetailsCited bySimmons M, Hillyer S, Lee B, Fergany A, Kaouk J and Campbell S (2018) Functional Recovery After Partial Nephrectomy: Effects of Volume Loss and Ischemic InjuryJournal of Urology, VOL. 187, NO. 5, (1667-1673), Online publication date: 1-May-2012.Related articlesJournal of Urology14 Aug 2009Initial Experience With Robot Assisted Partial Nephrectomy for Multiple Renal MassesJournal of Urology14 Aug 2009Guideline for Management of the Clinical T1 Renal Mass Volume 182Issue 4October 2009Page: 1582-1587 Advertisement Copyright & Permissions© 2009 by American Urological AssociationKeywordslaparoscopyroboticspolymerskidneynephrectomyAcknowledgmentsMichael Burns, Intuitive Surgical, Inc., and Phil Codyer, Robert Lichstein and Steven Binzel, Lahey Clinic assisted with the study. Intuitive Surgical, Inc. provided the robot.MetricsAuthor Information Alireza Moinzadeh Financial interest and/or other relationship with Intuitive Surgical. More articles by this author Sebastian Flacke More articles by this author John A. Libertino More articles by this author John Merhige Financial interest and/or other relationship with Pluromed. More articles by this author Jean-Marie Vogel Financial interest and/or other relationship with Intuitive Surgical. More articles by this author Katy Lyall Financial interest and/or other relationship with Intuitive Surgical. More articles by this author Curtis W. Bakal More articles by this author Peter N. Madras Financial interest and/or other relationship with Pluromed. More articles by this author Expand All Advertisement PDF downloadLoading ...