Marta Rossanese1, Alessandro Crestani2, Gianluca Giannarini3, Mattia Calandriello1, Giuseppe Alario1, Alchiede Simonato4, Vincenzo Ficarra5. 1. Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy. 2. Unit of Urology, Santa Maria Regina degli Angeli Hospital, Adria, Rovigo, Italy. 3. Unit of Urology, Santa Maria della Misericordia Academic Medical Center, Udine, Italy. 4. Department of Urology, University of Palermo, Palermo, Italy. 5. Section of Urology, Gaetano Barresi Department of Human and Pediatric Pathology, University of Messina, Messina, Italy - vficarra@unime.it.
Abstract
BACKGROUND: To compare perioperative and functional outcomes associated with renorrhaphy performed with two different types of clips (Absolok® vs. Hem-o-Lok®) in a contemporary series of patients who underwent partial nephrectomy. METHODS: Patients in whom Absolok® clips were used to perform haemostasis at the level of tumor bed or to block the running sutures during sliding-clip renorrhaphy (study group) were compared with a contemporary control group of patients in whom renorrhaphy was performed with Hem-o-Lok® clips. Both groups received the same surgical technique via an open or robot-assisted approach. Inner renorrhaphy was performed with one or more 3-0 (26 mm needle) monofilament running suture(s) preloaded with medium Absolok® clips in the study group, and with medium Hem-o-Lok® clips in the control group. Cortical renorrhaphy was performed using interrupted 2-0 (26 mm needle) polyfilament sutures placed at intervals of 1 cm using the sliding-clip technique with Absolok® clips in the study group and with Hem-o-Lok® clips in the control group. Intraoperative and postoperative outcomes were compared. RESULTS: Absolok® clips were used in 57 patients, while Hem-o-Lok® clips were used in 40 patients. The two groups were comparable for all preoperative patient and tumor characteristics. No differences were observed in terms of operating room time (P=0.29), off-clamp technique rate (P=0.96), warm ischemia time (P=0.19) and estimated blood loss (P=0.18). No difference in the rate of positive surgical margins was detected (P=0.21). Ninety-day complications were observed in 32 (33%) cases. No difference in overall and major postoperative complications were observed between the two groups (P=0.20). Abdominal CT scan performed after 3 months following surgery showed no Absolok® clips in all cases. CONCLUSIONS: Absolok® clips are a valid alternative to Hem-o-Lok® clips to secure blood vessels at the level of tumor bed and to perform a sliding-clip renorrhaphy in patients who underwent open or robot-assisted partial nephrectomy.
BACKGROUND: To compare perioperative and functional outcomes associated with renorrhaphy performed with two different types of clips (Absolok® vs. Hem-o-Lok®) in a contemporary series of patients who underwent partial nephrectomy. METHODS:Patients in whom Absolok® clips were used to perform haemostasis at the level of tumor bed or to block the running sutures during sliding-clip renorrhaphy (study group) were compared with a contemporary control group of patients in whom renorrhaphy was performed with Hem-o-Lok® clips. Both groups received the same surgical technique via an open or robot-assisted approach. Inner renorrhaphy was performed with one or more 3-0 (26 mm needle) monofilament running suture(s) preloaded with medium Absolok® clips in the study group, and with medium Hem-o-Lok® clips in the control group. Cortical renorrhaphy was performed using interrupted 2-0 (26 mm needle) polyfilament sutures placed at intervals of 1 cm using the sliding-clip technique with Absolok® clips in the study group and with Hem-o-Lok® clips in the control group. Intraoperative and postoperative outcomes were compared. RESULTS: Absolok® clips were used in 57 patients, while Hem-o-Lok® clips were used in 40 patients. The two groups were comparable for all preoperative patient and tumor characteristics. No differences were observed in terms of operating room time (P=0.29), off-clamp technique rate (P=0.96), warm ischemia time (P=0.19) and estimated blood loss (P=0.18). No difference in the rate of positive surgical margins was detected (P=0.21). Ninety-day complications were observed in 32 (33%) cases. No difference in overall and major postoperative complications were observed between the two groups (P=0.20). Abdominal CT scan performed after 3 months following surgery showed no Absolok® clips in all cases. CONCLUSIONS: Absolok® clips are a valid alternative to Hem-o-Lok® clips to secure blood vessels at the level of tumor bed and to perform a sliding-clip renorrhaphy in patients who underwent open or robot-assisted partial nephrectomy.