Thesis etd-09262023-134723 |
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Thesis type
Tesi di specializzazione (5 anni)
Author
MASTRANGELO, MATTIA
URN
etd-09262023-134723
Thesis title
Una nuova tecnica di renorrafia con suture continue autobloccanti e pledget allungati in corso di nefrectomia parziale robotica: studio caso-controllo con la tecnica tradizionale a cielo aperto
Department
PATOLOGIA CHIRURGICA, MEDICA, MOLECOLARE E DELL'AREA CRITICA
Course of study
CHIRURGIA GENERALE
Supervisors
relatore Prof. Morelli, Luca
Keywords
- enucleoresezione
- fistola urinosa
- pledget
- RENAL score
- renorrafia
- sutura autobloccante
Graduation session start date
07/11/2023
Availability
None
Summary
Con l’avanzamento delle tecniche e dell’expertise chirurgica,il trattamento chirurgico dei tumori renali è diventato quando tecnicamente fattibile di tipo conservativo (nefrectomia parziale).Questo risulta particolarmente importante in pazienti in pazienti con anamnesi positiva per malattia renale cronica o con neoformazioni multiple e/o bilaterali.Tale trattamento può essere eseguito sia mediante tecnica tradizionale a cielo aperto che mediante tecnica mini invasiva (laparoscopica o robotica).La nostra nuova tecnica di renorrafia a seguito di una nefrectomia parziale / enucleoresezione eseguita con approccio robotico,utilizzabile in modo sicuro anche per lesioni renali complesse con alto RENAL score,prevede l’utilizzo di suture continue autobloccanti con pledgets in PTFE allungati a rinforzo.Tale tecnica si è dimostrata sicura sia durante la fase intraoperatoria nel garantire una adeguata emostasi ma anche nel post-operatorio nell’incidenza delle principali complicanze di questo tipo di chirurgia,il sanguinamento e la fistola urinosa.Tale tecnica eseguita con modalità mini invasiva garantisce inoltre minori tempi di degenza post operatoria con tempi di recupero rapidi e migliore effetto cosmetico finale.Per quanto riguarda il tempo di ischemia calda,i tempi di clampaggio con tecnica mini invasiva robotica risultano maggiori rispetto ai tempi di clampaggio della tecnica tradizionale a cielo aperto ma rimanendo sempre all’interno dei tempi raccomandati nei principali lavori in letteratura.Ulteriori studi,eventualmente randomizzati e con un pool di pazienti più ampio,potrebbero essere utili per confermare o meno l’effettiva sicurezza di questa nuova tecnica di renorrafia.
With the advancement of surgical techniques and expertise,surgical treatment of renal tumors has become when technically feasible conservative (partial nephrectomy).This is particularly important in patients in patients with a positive history of chronic kidney disease or with multiple and/or bilateral neoformations.
This treatment can be performed either by traditional open technique or by minimally invasive technique (laparoscopic or robotic). Our new technique of renorrhaphy following partial nephrectomy/enucleoresection performed by robotic approach, which can be safely used even for complex renal lesions with high RENAL score, involves the use of continuous self-locking sutures with elongated PTFE pledgets for reinforcement.This technique has proven safe both during the intraoperative phase in ensuring adequate hemostasis but also in the postoperative phase in the incidence of the main complications of this type of surgery, bleeding and urinary fistula.This technique performed in a minimally invasive modality also ensures shorter postoperative hospital stay with quick recovery time and better final cosmetic effect.Regarding the time to warm ischemia, clamping times with the mini-invasive robotic technique appear to be longer than the clamping times of the traditional open technique but still remaining within the times recommended in the main works in the literature.
Further studies, possibly randomized and with a larger patient pool, might be useful to confirm or not the actual safety of this new renorrhaphy technique.
With the advancement of surgical techniques and expertise,surgical treatment of renal tumors has become when technically feasible conservative (partial nephrectomy).This is particularly important in patients in patients with a positive history of chronic kidney disease or with multiple and/or bilateral neoformations.
This treatment can be performed either by traditional open technique or by minimally invasive technique (laparoscopic or robotic). Our new technique of renorrhaphy following partial nephrectomy/enucleoresection performed by robotic approach, which can be safely used even for complex renal lesions with high RENAL score, involves the use of continuous self-locking sutures with elongated PTFE pledgets for reinforcement.This technique has proven safe both during the intraoperative phase in ensuring adequate hemostasis but also in the postoperative phase in the incidence of the main complications of this type of surgery, bleeding and urinary fistula.This technique performed in a minimally invasive modality also ensures shorter postoperative hospital stay with quick recovery time and better final cosmetic effect.Regarding the time to warm ischemia, clamping times with the mini-invasive robotic technique appear to be longer than the clamping times of the traditional open technique but still remaining within the times recommended in the main works in the literature.
Further studies, possibly randomized and with a larger patient pool, might be useful to confirm or not the actual safety of this new renorrhaphy technique.
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