Renal cancer. Contemporary management. Editor John A. Libertino. Springer New York 2013.
Hemostasis of the tumor bed
Achieving hemostasis is crucial during LPN as the most common postoperative complication requiring secondary procedure is delayed hemorrhage. Several techniques have been described. Following excision of the tumor, a central running Vicryl suture is placed in the resection site to oversew any bleeding vessels. If bleeding persists, then directed suture placement is done. If the collecting system was entered, this is closed in a watertight fashion. Renorrhaphy with or without the use of a bolster and hemostatic agents is performed by placing 2-0 Vicryl sutures with a Weck Hem-o-lok clip (Teleflex Medical, Kenosha, WI) on one end. Depending on the size of the tumor bed, 4–6 sutures are placed in mattress fashion through the renal parenchyma and secured by placing a Weck Hem-o-lok clip. Tsivian and colleagues describe a primary closure of the renal parenchyma without the use of hemostatic agents in 34 patients with tumor size ranging from 1.7 to 8.5 cm with one case of delayed hemorrhage postoperatively. The surgeon may use a bloster composed of oxidized cellulose polymer (Surgicel, Ethicon, Somerville, NJ, USA) along with a gelatin matrix (FloSeal, Baxter Healthcare Corporation, Fremont, CA, USA) injected between the bolster and tumor bed (Фиг. 14.4). Alternatively, when apposition of renal bed sides is possible, the bolster may be avoided.