REGULAR CONTENT
Final ID
412
Type
Original Scientific Research-Oral or Pos
Authors
R Ter-Oganesyan1, S Lundahl2, P Guichet3, R Flato3, G Passanante4, M Katz5
Institutions
1University of Southern California, Glendale, CA, 2University of Southern California, Los Angeles, CA, 3Keck School of Medicine of USC, Los Angeles, CA, 4N/A, Alhambra, CA, 5N/A, Los Angeles, CA
Purpose
Robot-assisted partial nephrectomy has become popular for the treatment of renal cell carcinoma by offering similar oncologic outcome and morbidity as laparoscopic or open technique, but with significant decreased hospital stay, shorter warm ischemia time, and lower intraoperative blood loss. In this review we outline our institution's experience in managing the post-operative hemorrhagic complications associated with robot-assisted partial nephrectomy using angiography and embolization.
Materials & Methods
Over a 50 month period from June 2012 through August 2015, retrospective review was performed of all Interventional Radiology procedures performed following robot-assisted partial nephrectomy. Patient demographics, symptom chronicity, and tumor characteristics were recorded. The indication for each procedure, angiographic findings, and therapeutic interventions were reviewed.
Results
1253 robot-assisted partial nephrectomies were performed in the review period. 17 angiograms were performed on 15 patients post-operatively (1.2%). Indication for all procedures was clinical evidence of post-surgical hemorrhage, including gross hematuria (9) or presence of hemorrhage on imaging performed for post-surgical pain (8). Selective renal angiography was performed on all 17 cases. Eighty-eight percent (15/17) of the procedures required embolization for pseudoaneurysm (6), active extravasation (5), arteriovenous fistula (1), combination of pseudoaneurysm and arteriovenous fistula (2), and isolated region of abnormal vascularity (1). Embolization material included n-butyl cyanoacrylate, ethylene vinyl alcohol, coils, and/or vascular plug. Twelve percent (2/17) of our procedures demonstrated no significantly abnormal angiographic findings to warrant therapeutic intervention. All patients were successfully treated without further bleeding although one patient required two separate interventions for multifocal injuries.
Conclusions
Interventional radiology plays an important role in the management of post-operative hemorrhagic complications of robot-assisted partial nephrectomy. Angiography with embolization can be safe and effective.
Final ID
412
Type
Original Scientific Research-Oral or Pos
Authors
R Ter-Oganesyan1, S Lundahl2, P Guichet3, R Flato3, G Passanante4, M Katz5
Institutions
1University of Southern California, Glendale, CA, 2University of Southern California, Los Angeles, CA, 3Keck School of Medicine of USC, Los Angeles, CA, 4N/A, Alhambra, CA, 5N/A, Los Angeles, CA
Purpose
Robot-assisted partial nephrectomy has become popular for the treatment of renal cell carcinoma by offering similar oncologic outcome and morbidity as laparoscopic or open technique, but with significant decreased hospital stay, shorter warm ischemia time, and lower intraoperative blood loss. In this review we outline our institution's experience in managing the post-operative hemorrhagic complications associated with robot-assisted partial nephrectomy using angiography and embolization.
Materials & Methods
Over a 50 month period from June 2012 through August 2015, retrospective review was performed of all Interventional Radiology procedures performed following robot-assisted partial nephrectomy. Patient demographics, symptom chronicity, and tumor characteristics were recorded. The indication for each procedure, angiographic findings, and therapeutic interventions were reviewed.
Results
1253 robot-assisted partial nephrectomies were performed in the review period. 17 angiograms were performed on 15 patients post-operatively (1.2%). Indication for all procedures was clinical evidence of post-surgical hemorrhage, including gross hematuria (9) or presence of hemorrhage on imaging performed for post-surgical pain (8). Selective renal angiography was performed on all 17 cases. Eighty-eight percent (15/17) of the procedures required embolization for pseudoaneurysm (6), active extravasation (5), arteriovenous fistula (1), combination of pseudoaneurysm and arteriovenous fistula (2), and isolated region of abnormal vascularity (1). Embolization material included n-butyl cyanoacrylate, ethylene vinyl alcohol, coils, and/or vascular plug. Twelve percent (2/17) of our procedures demonstrated no significantly abnormal angiographic findings to warrant therapeutic intervention. All patients were successfully treated without further bleeding although one patient required two separate interventions for multifocal injuries.
Conclusions
Interventional radiology plays an important role in the management of post-operative hemorrhagic complications of robot-assisted partial nephrectomy. Angiography with embolization can be safe and effective.