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ORIGINAL ARTICLE   Free accessfree

Minerva Urologica e Nefrologica 2020 February;72(1):91-8

DOI: 10.23736/S0393-2249.19.03598-7


lingua: Inglese

Absolok® versus Hem-o-Lok® clips for renorrhaphy during partial nephrectomy for parenchymal renal tumors

Marta ROSSANESE 1, Alessandro CRESTANI 2, Gianluca GIANNARINI 3, Mattia CALANDRIELLO 1, Giuseppe ALARIO 1, Alchiede SIMONATO 4, Vincenzo FICARRA 1

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

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.

KEY WORDS: Absolok® clips; Hem-o-Lok® clips; Renorrhaphy; Sliding clip technique; Partial nephrectomy; Perioperative outcomes; Complications; Renal cell carcinoma

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