Description of a multicenter safety checklist for intraoperative hemorrhage control while clamped during robotic partial nephrectomy

Patient Safety in Surgery

Sam B Bhayani²  Michael D Stifelman³  Robert S Figenshau⁶  Jihad H Kaouk¹  Mohamad E Allaf⁴  Craig G Rogers⁵  Gurdarshan S Sandhu⁶  Kenneth G Nepple⁶ 

[1] Cleveland Clinic, Cleveland, OH, USA;Department of Surgery, Division of Urology, Washington University School of Medicine, 660 S. Euclid Avenue, St Louis, MO 63110, USA;New York University School of Medicine, New York, NY, USA;Johns Hopkins University, Baltimore, MD, USA;Henry Ford Hospital, Detroit, MI, USA;Washington University School of Medicine, St. Louis, MO, USA

关键词: Patient safety;    Hemorrhage;    Nephrectomy;    Robotics;    Kidney neoplasms;   

Others  :  790357
DOI  :  10.1186/1754-9493-6-8

 received in 2012-02-19, accepted in 2012-04-02,  发布年份 2012

【 摘 要 】

Background

The adoption of robotic assistance has contributed to the increased utilization of partial nephrectomy for the management of renal tumors. However, partial nephrectomy can be technically challenging because of intraoperative hemorrhage, which limits the ability to identify the tumor margin and may necessitate the conversion to open surgery or radical nephrectomy. To our knowledge, a comprehensive safety checklist does not exist to guide surgeons on the management of hemorrhage during robotic partial nephrectomy. We developed such an safety checklist based on the cumulative experiences of high volume robotic surgeons.

Methods

A treatment safety checklist for the management of hemorrhage during robotic partial nephrectomy was collaboratively developed based on prior experiences with intraoperative hemorrhage during robotic partial nephrectomy.

Results

Reducing the risk of hemorrhage during robotic partial nephrectomy begins with reviewing the preoperative imaging for renal vasculature and tumor anatomy, with a focus on accessory vessels and renal tumor proximity to the renal hilum. During hilar exposure, an attempt is made to identify additional accessory renal arteries. The decision is then made on whether to clamp the hilum (artery +/- vein). If bleeding is encountered during resection, management is based on whether the bleeding is suspected to be arterial or from venous backbleeding. Operative maneuvers that may increase the chance of success are highlighted in safety checklists for arterial and venous bleeding.

Conclusions

Safely performing robotic partial nephrectomy is dependent on attention to prevention of hemorrhage and rapid response to the challenge of intraoperative bleeding. Preparation is essential for maximizing the chance of success during robotic partial nephrectomy.

【 授权许可】

   
2012 Nepple et al; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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