The margin resected at partial nephrectomy is so fragile that it is not easy to control bleeding. To control bleeding we developed a new technique using a vascular sealing system for hemostasis.
A 38-year-old woman with renal cell carcinoma underwent partial nephrectomy. A tumor was identified in the lower pole of the left kidney. The kidney was exposed with the perinephric fat and the main renal artery was identified and clamped. Along the incision line the renal cortex was cut sharply to 10 to 15 mm. deep. A jaw of the vascular sealing system was carefully inserted into the sinus space between the renal pelvis and medulla. The jaws were gradually clamped together, and the renal medulla and vasculature were compressed and then sealed completely by computer controlled current. Because the renal pelvis was involved by tumor, the pelvis was removed partially with the tumor and approximated with absorbable sutures.
Before reperfusion only a few additional sutures were needed for hemostasis. Warm ischemia time was 19 minutes.
Our technique seems to be a promising method of rapidly achieving reliable hemostasis for partial nephrectomy.
[Show abstract][Hide abstract] ABSTRACT: Orientador: Sérgio Ossamu Ioshii Inclui apęndice Tese (doutorado) - Universidade Federal do Paraná, Setor de Cięncias da Saúde, Programa de Pós-Graduaçăo em Clínica Cirúrgica. Defesa: Curitiba, 2003 Inclui bibliografia e anexos
[Show abstract][Hide abstract] ABSTRACT: Surgical operative performance benefits from analysis of the mechanisms underlying technical errors committed during surgery.
Prospective study using the Observational Clinical Human Reliability Assessment (OCHRA) system and complete unedited videotapes of the operations.
Three National Health Service hospitals within the United Kingdom.
Two hundred consecutive patients with symptomatic gallstone disease.
Elective laparoscopic cholecystectomy for symptomatic gallstone disease by surgeons, who were blind to the nature and objectives of the study, using their usual operative technique.
Surgical consequential and inconsequential operative errors.
The analysis of 38 062 steps of the 200 laparoscopic cholecystectomies performed by 26 surgeons identified 2242 errors. The mean +/- SD total, inconsequential, and consequential errors per surgical procedure were 11.0 +/- 8.0, 8.0 +/- 6.0, and 4.0 +/- 3.0, respectively. Dissection of the Calot triangle (second task zone of the operation) incurred more total errors (6.5 +/- 5.4) compared with the first (2.9 +/- 2.8, P<.001) and third (5.1 +/- 3.9, P<.05) task zones. This translated to a higher error probability (6.9% vs 3.5% for the first and 5.5% for third task zones). The combined sharp and blunt dissection method had fewer errors than the blunt/teasing dissection technique (9.45 +/- 7.6 vs 13.9 +/- 7.3, P<.001) although different surgeons were involved. The most serious consequences were encountered during dissection with the electrosurgical hook knife.
This study has confirmed that the Observational Clinical Human Reliability Assessment system provides a comprehensive objective assessment of the quality of surgical operative performance by documenting the errors, the stage of the operation in which errors are enacted most frequently, and where these errors have serious consequences (hazard zones).
Archives of Surgery 11/2004; 139(11):1215-20. DOI:10.1001/archsurg.139.11.1215 · 4.93 Impact Factor
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