Convenient Creation And Use Of Suturing Supplies For Laparoscopic Partial Nephrectomy

Main Category: Urology / Nephrology
Article Date: 26 Oct 2009 - 4:00 PDT

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UroToday.com - As many have stated, one of the most trying and taxing laparoscopic procedures is that of partial nephrectomy with the need to reconstruct the collecting system. This requires the surgeon to suture under the pressure of time constraints in order to preserve the very function of the organ on which he/she is operating. In this "how to" article, Dr. J. Stuart Wolf nicely describes the creation of a 0 polyglycolic acid, double CT-1 needle bearing oxidized cellulose bolster. This bolster is placed in the abdomen, along with other sutures that may be needed for the reconstruction, prior to clamping the renal vessels; as such, during the reconstruction there is no need to pass additional needles into the abdomen.

Accordingly, following argon beam coagulation of the parenchyma and closure of any collecting system defect larger than the bolster, the needle-bearing bolster is placed into the partial nephrectomy defect. The pair of needles on the bolster is sequentially passed from the inside to the outside on either side of the defect and each is then firmly secured where it exits the parenchyma with a Hem-o-lok clip. Two additional 0 polyglycolic acid sutures, each with a knotted Hem-o-lok clip at 3 inches are placed at either end of the defect to further secure the bolster in place and close the defect; these two simple sutures, after passage outside-in on the parenchyma on one side, over or through the bolster in the defect, and then inside-out on the other side of the parenchyma, are then firmly secured on the second side where they exit the parenchyma with a Hem-o-lok clip. With this method, the bolster can be rapidly and securely fixed in place.

Wolf JS Jr
J Endourol. 2009 Jul;23(7):1121-6
10.1089/end.2009.0006

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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