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POD-10.04: Autologous fibrin glue using the vivostat system for hemostasis in laparoscopic partial nephrectomy
PODIUM SESSIONS
noma, 9 cases of Cushing’s syndrome, 7 cases of Conn’s syndrome, 12 cases of pheochromocytoma, incidentaloma in 8 cases, and other pathological conditions such as adrenal cysts, non functioning adenoma, and myolipomas in 9 cases. Conclusions: Evaluation of laparoscopic adrenalectomy has demonstrated obvious advantages when compared with open surgical techniques. We reported less operative blood loss, decreased pain, shorter hospital stay and a quicker return to normal activities. Once progress has been made on the learning curve, the operative time turns to be equal to open surgery. Laparoscopic adrenalectomy has now become an accepted, and in many institutions the preferred, method for removal of benign adrenal pathology 6 cm or less. POD-10.04 Autologous fibrin glue using the vivostat system for hemostasis in laparoscopic partial nephrectomy Cindolo L1, Gidaro S2, Lipsky K3, Dalpiaz O3, Zigeuner R3, Schips L2 1 Urology Unit, G. Rummo Hospital, Benevento, Italy; 2Urology Unit, Vasto Hospital (CH), Italy; 3Department of Urology, Medical University Graz, Austria Objectives: Haemostasis remains the greatest challenge during laparoscopic partial nephrectomy. Use of fibrin sealant currently is increasing. We describe first a technique for achieving effective haemostasis during laparoscopic partial nephrectomy using the Vivostat™ system. Methods: Twenty nine patients underwent laparoscopic partial nephrectomy. Autologous fibrin sealant was prepared with the Vivostat™ system and applied to the resection bed. This system is an automated medical device for the preparation of an autologous fibrin sealant, generating up to 5ml of sealant from 120ml of the patient’s blood. The concentration of fibrin and the volume of sealant are stable; the sealant may be kept at room temperature for up to 8hours before application without a loss of properties and effectiveness. The patients were evaluated for acute and delayed bleeding. Results: Mean patient’s age was 57.5 years (range, 23-76). Haemostasis was immediate in all cases after application of the sealant for 1 to 2minutes to the resection site (mean amount applied: 5.1ml). Six resection were performed without ilar clamping, whereas the mean warm ischemia time was 26minutes (range, 16-45) for 23 interventions.
Mean blood loss was 128 cc (range, 20 – 500). Pre-operative and post-operative serum haemoglobin did not differ significantly (mean, 14.7 vs 12.5g/dl) and creatinine values (mean, 0.91 vs 1ng/ml). Mean operative time was 131minutes (range, 60 –190). One intraoperative bleeding occurred needing blood transfusion (1 unit). Postoperatively, we observed 1 perirenal haematoma treated conservatively requiring blood transfusion (4 units). Conclusions: In this study, immediate haemostasis was achieved and maintained after the kidney reperfusion. Our initial experience with the Vivostat™ system in laparoscopic partial nephrectomy has been encouraging. POD-10.05 The prognostic impact of comorbidities in patients with renal cancer, 1985-2004: a Danish population-based study Lund L1,2, Riis A3, Nørgård M3, McLaughlin J4, Blot B2,4, Sørensen H2,3,5 1 Department Of Urology, Viborg Hospital, Denmark; 2Centre of Health Research, Vanderbilt University Hospital, TN, USA; 3Department of Epidemiology, Aarhus University, Aarhus, Denmark; 4 International Epidemiology Institute, Rockville, MD, USA; 5Department of Epidemiology, Boston University, MA, USA Objective: We examined the influence of comorbidity (CM) on the survival of patients with renal cancer in Northern Denmark because the impact of CM in patients with renal cancer is largely unknown. Methods: All patients with an incident discharge diagnosis of renal cancer between 1985 and 2005 (n⫽4224 within a population of 1.6 million). We computed Charlson Comorbidity Index scores (0, 1-2, 3⫹) and estimated the prevalence of CM, the absolute and relative survival estimates according to CM level, using patients with Charlson score 0 as the reference group. Results: There was 1794 women with a median age was 70 years (range 18-97 years) and 2420 men aged 68 years (range 15-96 years) and of these 1499 (36%) patients had CM. The prevalence of patients with CM scores of 0 decreased from 71% to 58%, while the number of patients with CM scores 1-2 increased from 22% to 28% and those with CM scores of 3⫹ increased form 7% to 14% during the four time periods. The 1-year survival rates increased from 54% to 57% over time. Overall, patients diagnosed in 2000-2005 had a
UROLOGY 70 (Supplment 3A), September 2007
lower age-, sex- and co-morbidity-adjusted mortality (1-year MRR⫽0.90; 95% CI⫽0.79-1.02) compared to those diagnosed in 1985-1989 (reference). Five-year survival rates were unchanged 33%-34%33% in the three time periods and the relative mortality fell to 0.95 (1995-1999) when adjusted for age, sex and co-morbidity. Conclusion: Comorbidities overall are increasing among renal cancer patients. The increasing comorbidity is a poor prognostic factor in patients with renal cancer.
POD-10.06 Predictors of laparoscopic adrenalectomy morbidity Castillo O1,2, Secin F3, Kerkebe M1, Vitagliano G1, Sanchez-Salas R1, Dı´az M1, Foneron A1 1 Section of Endourology and Laparoscopic Urology, Department of Urology, Clı´nica Santa Maria; 2Department of Urology, School of Medicine, Universidad de Chile; 3CEMIC University Hospital, Buenos Aires, Argentina Introduction: Our aim was to estimate the morbimortality of laparoscopic adrenalectomy and identify factors associated with operative complications. Methods: Since 1993, 229 patients underwent laparoscopic adrenalectomy by a single surgeon. Demographic, clinical and pathologic data were evaluated to identify their association with operative complications, using univariate logistic regression analysis. Results: The median (IQR) age was 52 (38, 63), 62% were females, 51% located on the right side and 49% were found incidentally. The median maximum tumor diameter was 5 cm (3, 6.5) and 18% were malignant. The median (IQR) operative time was 70 minutes (55, 91), estimated blood loss (EBL) 50cc. (30,150) and hospital stay 2 days (2, 3). One patient was converted. Surgery related complications ascended to 8% of patients (95%CI: 5, 12), which included: 3 intraoperative bleedings, 3 diaphragmatic injuries, 3 incisional hernias, 2 retroperitoneal hematomas, 2 renal vein lacerations, 1 spenic injury 1, 1 hyponatremia and 1 patient with pheocromocytoma suffered an intraoperative cardiac arrest and died. Variables significantly associated with these complications included extended operative time (p0.018), increased EBL (p⬍0.001), and perioperative transfusions (p⬍0.001). Maximum tumor diameter, side, age, gender, co morbidities, tumor related symptoms, tumor histology, performance of adrenalectomy in combination with another surgery and case
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noma, 9 cases of Cushing’s syndrome, 7 cases of Conn’s syndrome, 12 cases of pheochromocytoma, incidentaloma in 8 cases, and other pathological conditions such as adrenal cysts, non functioning adenoma, and myolipomas in 9 cases. Conclusions: Evaluation of laparoscopic adrenalectomy has demonstrated obvious advantages when compared with open surgical techniques. We reported less operative blood loss, decreased pain, shorter hospital stay and a quicker return to normal activities. Once progress has been made on the learning curve, the operative time turns to be equal to open surgery. Laparoscopic adrenalectomy has now become an accepted, and in many institutions the preferred, method for removal of benign adrenal pathology 6 cm or less. POD-10.04 Autologous fibrin glue using the vivostat system for hemostasis in laparoscopic partial nephrectomy Cindolo L1, Gidaro S2, Lipsky K3, Dalpiaz O3, Zigeuner R3, Schips L2 1 Urology Unit, G. Rummo Hospital, Benevento, Italy; 2Urology Unit, Vasto Hospital (CH), Italy; 3Department of Urology, Medical University Graz, Austria Objectives: Haemostasis remains the greatest challenge during laparoscopic partial nephrectomy. Use of fibrin sealant currently is increasing. We describe first a technique for achieving effective haemostasis during laparoscopic partial nephrectomy using the Vivostat™ system. Methods: Twenty nine patients underwent laparoscopic partial nephrectomy. Autologous fibrin sealant was prepared with the Vivostat™ system and applied to the resection bed. This system is an automated medical device for the preparation of an autologous fibrin sealant, generating up to 5ml of sealant from 120ml of the patient’s blood. The concentration of fibrin and the volume of sealant are stable; the sealant may be kept at room temperature for up to 8hours before application without a loss of properties and effectiveness. The patients were evaluated for acute and delayed bleeding. Results: Mean patient’s age was 57.5 years (range, 23-76). Haemostasis was immediate in all cases after application of the sealant for 1 to 2minutes to the resection site (mean amount applied: 5.1ml). Six resection were performed without ilar clamping, whereas the mean warm ischemia time was 26minutes (range, 16-45) for 23 interventions.
Mean blood loss was 128 cc (range, 20 – 500). Pre-operative and post-operative serum haemoglobin did not differ significantly (mean, 14.7 vs 12.5g/dl) and creatinine values (mean, 0.91 vs 1ng/ml). Mean operative time was 131minutes (range, 60 –190). One intraoperative bleeding occurred needing blood transfusion (1 unit). Postoperatively, we observed 1 perirenal haematoma treated conservatively requiring blood transfusion (4 units). Conclusions: In this study, immediate haemostasis was achieved and maintained after the kidney reperfusion. Our initial experience with the Vivostat™ system in laparoscopic partial nephrectomy has been encouraging. POD-10.05 The prognostic impact of comorbidities in patients with renal cancer, 1985-2004: a Danish population-based study Lund L1,2, Riis A3, Nørgård M3, McLaughlin J4, Blot B2,4, Sørensen H2,3,5 1 Department Of Urology, Viborg Hospital, Denmark; 2Centre of Health Research, Vanderbilt University Hospital, TN, USA; 3Department of Epidemiology, Aarhus University, Aarhus, Denmark; 4 International Epidemiology Institute, Rockville, MD, USA; 5Department of Epidemiology, Boston University, MA, USA Objective: We examined the influence of comorbidity (CM) on the survival of patients with renal cancer in Northern Denmark because the impact of CM in patients with renal cancer is largely unknown. Methods: All patients with an incident discharge diagnosis of renal cancer between 1985 and 2005 (n⫽4224 within a population of 1.6 million). We computed Charlson Comorbidity Index scores (0, 1-2, 3⫹) and estimated the prevalence of CM, the absolute and relative survival estimates according to CM level, using patients with Charlson score 0 as the reference group. Results: There was 1794 women with a median age was 70 years (range 18-97 years) and 2420 men aged 68 years (range 15-96 years) and of these 1499 (36%) patients had CM. The prevalence of patients with CM scores of 0 decreased from 71% to 58%, while the number of patients with CM scores 1-2 increased from 22% to 28% and those with CM scores of 3⫹ increased form 7% to 14% during the four time periods. The 1-year survival rates increased from 54% to 57% over time. Overall, patients diagnosed in 2000-2005 had a
UROLOGY 70 (Supplment 3A), September 2007
lower age-, sex- and co-morbidity-adjusted mortality (1-year MRR⫽0.90; 95% CI⫽0.79-1.02) compared to those diagnosed in 1985-1989 (reference). Five-year survival rates were unchanged 33%-34%33% in the three time periods and the relative mortality fell to 0.95 (1995-1999) when adjusted for age, sex and co-morbidity. Conclusion: Comorbidities overall are increasing among renal cancer patients. The increasing comorbidity is a poor prognostic factor in patients with renal cancer.
POD-10.06 Predictors of laparoscopic adrenalectomy morbidity Castillo O1,2, Secin F3, Kerkebe M1, Vitagliano G1, Sanchez-Salas R1, Dı´az M1, Foneron A1 1 Section of Endourology and Laparoscopic Urology, Department of Urology, Clı´nica Santa Maria; 2Department of Urology, School of Medicine, Universidad de Chile; 3CEMIC University Hospital, Buenos Aires, Argentina Introduction: Our aim was to estimate the morbimortality of laparoscopic adrenalectomy and identify factors associated with operative complications. Methods: Since 1993, 229 patients underwent laparoscopic adrenalectomy by a single surgeon. Demographic, clinical and pathologic data were evaluated to identify their association with operative complications, using univariate logistic regression analysis. Results: The median (IQR) age was 52 (38, 63), 62% were females, 51% located on the right side and 49% were found incidentally. The median maximum tumor diameter was 5 cm (3, 6.5) and 18% were malignant. The median (IQR) operative time was 70 minutes (55, 91), estimated blood loss (EBL) 50cc. (30,150) and hospital stay 2 days (2, 3). One patient was converted. Surgery related complications ascended to 8% of patients (95%CI: 5, 12), which included: 3 intraoperative bleedings, 3 diaphragmatic injuries, 3 incisional hernias, 2 retroperitoneal hematomas, 2 renal vein lacerations, 1 spenic injury 1, 1 hyponatremia and 1 patient with pheocromocytoma suffered an intraoperative cardiac arrest and died. Variables significantly associated with these complications included extended operative time (p0.018), increased EBL (p⬍0.001), and perioperative transfusions (p⬍0.001). Maximum tumor diameter, side, age, gender, co morbidities, tumor related symptoms, tumor histology, performance of adrenalectomy in combination with another surgery and case
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