Document Detail


Temporary segmental renal artery occlusion using reverse phase polymer for bloodless robotic partial nephrectomy.
MedLine Citation:
PMID:  19683769     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
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. Ongoing studies are under way to assess technique consistency and the long-term effects of the polymer.
Authors:
Alireza Moinzadeh; Sebastian Flacke; John A Libertino; John Merhige; Jean-Marie Vogel; Katy Lyall; Curtis W Bakal; Peter N Madras
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2009-08-15
Journal Detail:
Title:  The Journal of urology     Volume:  182     ISSN:  1527-3792     ISO Abbreviation:  J. Urol.     Publication Date:  2009 Oct 
Date Detail:
Created Date:  2009-09-14     Completed Date:  2009-10-02     Revised Date:  2013-06-02    
Medline Journal Info:
Nlm Unique ID:  0376374     Medline TA:  J Urol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1582-7     Citation Subset:  AIM; IM    
Affiliation:
Lahey Clinic, Burlington and Pluromed, Inc., Woburn, Massachusetts 01805, USA. moinza00@lahey.org
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MeSH Terms
Descriptor/Qualifier:
Animals
Blood Loss, Surgical / prevention & control*
Embolization, Therapeutic / methods*
Feasibility Studies
Hemostasis, Surgical / methods*
Laparoscopy*
Nephrectomy / methods*
Poloxamer*
Renal Artery*
Robotics*
Swine
Time Factors
Grant Support
ID/Acronym/Agency:
1R43DK079481-01/DK/NIDDK NIH HHS; R43 DK079481-01/DK/NIDDK NIH HHS
Chemical
Reg. No./Substance:
0/LeGoo; 106392-12-5/Poloxamer
Comments/Corrections

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