背景:在机器人辅助的肾部分切除术(RAPN)中,肾吻合术用于实现肿瘤切除床的止血控制,对肾功能有不利影响。止血剂用于实现快速和最佳的止血。GATT-Patch是一种新的止血密封剂,已经证明了有希望的结果。目的:从止血能力方面比较GATT-Patch和标准renorraphy,缺血时间,在猪模型中预防RPN后的尿漏。设计,设置,和参与者:在这项临床前随机对照试验中,四头猪接受了32次RPN检查。切除后,GATT-Patch的应用和经典肾动脉造影的性能是随机的。手术后,再次检查切除床.尸检研究评估了贴片的粘附性,并进行逆行肾盂造影以确定泄漏爆裂压力。干预:GATT-Patch的应用和经典的肾动脉造影的表现是随机的,外科医生不知道要进行的止血技术。结果测量和统计分析:热缺血,止血控制,止血控制期间的活动性出血,总手术时间,复查时出血,并记录逆行肾盂造影中是否存在尿漏。使用学生t检验比较连续变量。使用卡方检验或Fisher精确检验比较分类变量。结果和局限性:GATT-Patch减少了热缺血时间(WIT),达到止血控制的时间,活动性出血时间,和总手术时间,在100%的情况下实现止血。0%的GATT-Patch组患者复检时再出血。在100%的肾修补术病例和0%的GATT-Patch病例中观察到肾实质损害。结论:GATT-Patch在猪模型中保证了RAPN后最佳的止血和补尿效果。与renorraphy相比,我们观察到WIT的减少,总手术时间,和潜在的减少健康的实质损失。患者概述:GATT-贴片在猪中切除部分肾之后比缝合更快地止血并提供止血。可能会在接受肾癌部分肾切除术的患者中进行测试。
Background: In robot-assisted partial nephrectomy (RAPN)
renorrhaphy is used to achieve hemostatic control of the tumoral resection bed, with detrimental impact on renal function. Hemostatic agents are used to achieve rapid and optimal hemostasis. GATT-Patch is a new hemostatic sealant that has already demonstrated promising results. Objective: Compare GATT-Patch and standard
renorrhaphy in terms of hemostatic capacity, ischemia time, and prevention of urinary leakage after RAPN in a porcine model. Design, Setting, and Participants: In this preclinical randomized controlled trial, four pigs underwent 32 RAPNs. After resection, GATT-Patch application and performance of classic
renorrhaphy were randomized. After the procedure, the resection bed was reinspected. A necropsy study evaluated the adhesiveness of the patch, and retrograde pyelography was performed to determine the leakage burst pressure. Intervention: Application of GATT-Patch and performance of classic renorrhaphy were randomized and surgeons blinded to the hemostatic technique to be performed. Outcome Measurements and Statistical Analysis: Warm ischemia, hemostatic control, active bleeding during hemostatic control, total procedure time, bleeding at reinspection, and presence of urinary leakage on retrograde pyelography were recorded. Continuous variables were compared using the Student t-test. Categorical variables were compared using the Chi-square or Fisher\'s exact test. Results and Limitations: GATT-Patch reduced warm ischemia time (WIT), time to achieve hemostatic control, active bleeding time, and total procedure time, achieving hemostasis in 100% of the cases. Rebleeding at reinspection occurred in 0% of the GATT-Patch group. Renal parenchyma damage was observed in 100% of
renorrhaphy cases and in 0% of GATT-Patch cases. Conclusions: GATT-Patch guaranteed optimal hemostasis and urine sealant effect after RAPN in porcine models. Compared to
renorrhaphy, we observed a reduction in WIT, total procedure time, and potential reduction in healthy parenchyma loss. Patient Summary: GATT-Patch stops bleeding and provides hemostasis faster than suturing after resection of portions of the kidney in pigs. It might be tested in patients undergoing partial nephrectomy for kidney cancer.