Böbrek naklinde vasküler anastomoz zamanı açısından konvansiyonel portegü ile castroviejo portegünun karşılaştırılması

Yıl 2022, Cilt: 14 Sayı: 3, 77 - 83, 30.09.2022

İsmail Evren , Deniz Noyan Özlü , Mithat Ekşi , Ahmet Faysal Güler , Serdar Karadağ , Hakan Polat , Taner Kargı , Ahmet Haciislamoğlu , Ferhat Yakup Suçeken

https://doi.org/10.54233/endouroloji.1161940

Öz

Amaç: Renal vasküler yapıların anastomoz süresinin uzamaması, sıcak ve soğuk iskeminin potansiyel zararlı etkisini en aza indirmek adına önemlidir. Çalışmamızın amacı, renal transplantasyon esnasında vasküler anastomozda kullanılan portegü tasarımının, anastomoz süresine olan etkisini belirlemektedir.
Gereç ve Yöntemler: Eylül 2011 ve Şubat 2020 tarihleri arasında kliniğimizde yapılan böbrek nakli vakaları retrospektif olarak incelendi. Anastomozlarda kullanılan iki tip portegüye göre hastalar gruplara ayrıldı. Grup 1’de konvansiyonel tipte, Hegar tipi makas tutucusuna sahip Ryder Diadust, düz, 180mm (7”) portegü kullanılmıştır. Grup 2’de, kalem portegü tipinde, Castroviejo Durogrip TC Micro Needle Holder, düz, 215mm (8 ½”) kullanılmıştır. Her iki grup arasında demografik özellikler, vasküler karakteristikler ve vasküler anastomoz süreleri karşılaştırılmıştır.
Bulgular: Toplam 75 hasta çalışmaya dahil edildi. Grup 1’de toplam 39 (52%), Grup 2’de 36 (48%) hasta mevcuttu. Tüm hasta grubunda ortalama arter sayısı 1,2 ± 0,4, ortalama arter çapı 5,3 ± 1,2 mm bulunmuş olup, her iki grup arasında bu değerler arası istatistiksel anlamlı fark yoktu (p=0,196 ve 0,304, sırasıyla). Ortalama arteryal anastomoz süresi Grup 1’de 15 ± 5,1, Grup 2’de 10 ± 3,9 dakikadır. Ortalama venöz anastomoz süreleri ise Grup 1’de 18,4 ± 6,1 ve Grup 2’de 14,7 ± 4 dakikadır. Yapılan istatistiksel analizde Grup 2’de arteryal ve ven anastomoz sürelerinin anlamlı olarak Grup 1’den daha kısa olduğu bulunmuştur (p= 0,038 ve p= 0,020, sırasıyla).
Sonuç: Çalışmamızda, renal transplant esnasında yapılan anastomozda kalem tipi Catroviejo portegü kullanılan grupta renal arterial ve venöz anastomoz sürelerinin anlamlı olarak daha kısa olduğu bulunmuştur.

Anahtar Kelimeler

vasküler anastomoz, portegü, böbrek nakli

Comparison of conventional and castroviejo needle holders in terms of vascular anastomosis time in renal transplant

Öz

Objective: It is important that the anastomosis time of renal vascular structures is not prolonged to minimize the potentially harmful effect of warm and cold ischemic times. This study aimed to determine the effect of the needle holder design used in vascular anastomosis during renal transplantation on the duration of anastomosis.
Material and Methods:  Patients that underwent renal transplantation at our clinic between September 2011 and February 2020, were divided into groups according to the two types of needle holders used in anastomoses. In Group 1, a conventional, Hegar-type, straight, 180-mm (7”) Ryder Diadust needle holder was used. In Group 2, a pen-type, straight, 215-mm (8 ½”) Castroviejo Durogrip TC micro needle holder was used. Demographic characteristics, vascular characteristics, and vascular anastomosis times were compared between the two groups. 
Results: A total of 75 patients were included in the study. There were 39 (52%) patients in Group 1 and 36 (48%) patients in Group 2. The mean number of arteries was 1.2 ± 0.4, and the mean arterial diameter was 5.3 ± 1.2 mm in the whole cohort, with no statistically significant difference between the two groups (p=0.196 and 0.304, respectively). The mean arterial anastomosis time was 15 ± 5.1 minutes in Group 1 and 10 ± 3.9 minutes in Group 2. The mean venous anastomosis times were 18.4 ± 6.1 in Group 1 and 14.7 ± 4 minutes in Group 2. In the statistical analysis, the arterial and vein anastomosis times were found to be significantly shorter in Group 2 than in Group 1 (p=0.038 and p=0.020, respectively).
Conclusion: In our study, it was observed that the renal arterial and venous anastomosis times were significantly shorter in the group in which the pen-type Castroviejo needle holder was used in anastomoses performed during renal transplantation.

Anahtar Kelimeler

Renal transplant, vascular anastomosis, needle holder

Kaynakça

• 1. Heylen L, Naesens M, Jochmans I, et al. The effect of anastomosis time on outcome in recipients of kidneys donated after brain death: a cohort study. Am J Transplant. 2015;15(11):2900-7 doi: 10.1111/ajt.13397.
• 2. Rod X, Peyronnet B, Seisen T, et al. Impact of ischaemia time on renal function after partial nephrectomy: a systematic review. BJU Int. 2016;118(5):692-705 doi:10.1111/bju.13580
• 3. Hellegering J, Visser J, Kloke HJ, et al. Deleterious influence of prolonged warm ischemia in living donor kidney transplantation. Transplant Proc. 2012;44(5):1222-1226 doi:10.1016/j.transproceed.2012.01.118
• 4. Moritz WR, Raman S, Pessin S, et al. The History and Innovations of Blood Vessel Anastomosis. Bioengineering (Basel). 2022;15;9(2):75 doi:10.3390/bioengineering9020075.
• 5. Abdelall ES, Stone RT, Rajana Nedved L, Fales C. Bend the Tool, Not the Wrist: An Ergonomic Investigation of Medical Suturing Needle Holder Design and Medical Engineering Solution. Surg Innov. 2021;28(1):62-70 doi: 10.1177/1553350620950896.
• 6. Van Veelen M, Meijer D, Uijttewaal I, Goossens R, Snijders C, Kazemier G. Improvement of the laparoscopic needle holder based on new ergonomic guidelines. Surg Endosc. 2003;17(5):699–703 https://doi.org/10.1007/s00464- 002-9186-y.
• 7. Catanzarite T, Tan-Kim J, Whitcomb EL, Menefee S. Ergonomics in surgery: a review. Female Pelvic Med Reconstr Surg. 2018;24(1):1–12 https://doi.org/10.1097/SPV.0000000000000456.
• 8. Frimand Rönnow C-F, Jeppsson B, Thorlacius H, et al. Frimand needle holder reduces suturing time and surgical stress when suturing in palm grip. Surg Innov. 2016;23(3):235–41 https://doi.org/10.1177/1553350615610649.
• 9. Hacıislamogul A, Arıkan Y, Evren İ, et al. New Incision Method for Kidney Transplantation:Single-Center Experience. J Reconstr Urol. 2020;10(3):75-9 doi: 10.5336/urology.2020-76617
• 10. Carrel A, Guthrie CC. Functions of a transplanted kidney. Science. 1905;22:473.
• 11. Marzouk K, Lawen J, Alwayn I, Kiberd BA. The impact of vascular anastomosis time on early kidney transplant outcomes. Transplant Res. 2013;2(1):8 doi:10.1186/2047-1440-2-8
• 12. Ferede AA, Walsh AL, Davis NF, et al. Warm Ischemia Time at Vascular Anastomosis is an Independent Predictor for Delayed Graft Function in Kidney Transplant Recipients. Exp Clin Transplant. 2020;18(1):13-18 doi:10.6002/ect.2018.0377
• 13. Kuipers TG, Hellegering J, El Moumni M, et al. Kidney temperature course during living organ procurement and transplantation. Transpl Int. 2017;30(2):162-169 doi:10.1111/tri.12892
• 14. Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol. 2009;56:625–634 doi:10.1016/j.eururo.2009.07.016
• 15. Thompson RH, Lane BR, Lohse CM, et al. Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol. 2010;58:340–345 doi:10.1016/j.eururo.2010.05.047
• 16. Hawkins DB. A needle holder for vascular and plastic surgery. Am J Surg. 1976;132(5):678. doi:10.1016/0002-9610(76)90376-7
• 17. Ohata E, Matsuo K, Ban R, Shiba M, Yasunaga Y. Electromyographic comparison of forearm muscle movements for fine skin suturing between an enlarged pen needle holder and a webster needle holder. Eplasty. 2013;6;13:e22.
• 18. Yue Gao, Sharmila Dissanaike. The Castroviejo Needle Holder [Internet]. General Surgery News 2016 Available from: https://www.generalsurgerynews.com/Technology/Article/07-16/The-Castroviejo-Needle-Holder/38549
• 19. Fitts PM. Perceptual-motor skill learning. In Melton AW, ed. Categories of Human Learning. New York, NY: Academic Press; 1964:47-78.
• 20. Ohbayashi M, Ohki K, Miyashita Y. Conversion of working memory to motor sequence in the monkey premotor cortex. Science. 2003;301:233-6. doi:10.1126/science.1084884
• 21. Averay K, van Galen G, Ward M, Verwilghen D. Effect of three different needle holders on gastrointestinal anastomosis construction time and bursting pressure in equine jejunal segments. BMC Vet Res. 2021;17(1):167. doi:10.1186/s12917-021-02871-4.