Year 2015 Vol. 23 No 3

UROLOGY

V.M. POPKOV, D.Y. POTAPOV, A.N. PONUKALIN

THE FEASIBILITY OF MATHEMATICAL MODELING FOR HEMOSTATIC SUTURES COMPARISON IN A PARTIAL NEPHRECTOMY

SBEE HPE "Saratov State Medical University Named after V.I. Razumovsky",
The Russian Federation

Objectives. On the basis of the proposed model to study effect of different modifications of hemostatic sutures on the renal parenchyma in the site of resection.
Material and Methods. To study the deformation degree of the renal parenchyma in tightening of the hemostatic suture and the compression degree of the parenchyma by threads during partial nephrectomy 3 different finite element models using modified technique of double interrupted, U-shaped sutures have been created. The force equal to 1N as an equivalent of thread tightening was applied to them. Thread thickness was 0,2 mm.
Results. The simulation results have found the double ligature suture considered to be the most parenchyma-sparing procedure. The narrow zone of excessive compression allows applying much more force to tightening of the suture without any fear of its eruption and increasing bleeding as within the operation as in the immediate postoperative period. In tightening of the double ligature suture the most displacement falls on the suture exit points on the parenchymal surface and a thick layer of perinephric adipose tissue obligatory used in the imposition of given suture. Meanwhile, the segments of the parenchyma as inside of an organ as between the superposed sutures remain practically intact to the displacement and, therefore, are under the best conditions for primary healing of surgical wounds.
Conclusion. The application of continuous suture is considered to be expedient in its imposition only on the renal capsule which is hermetically closed afterwards. The most suitable method recommended for use is thought to be a double ligature suture providing optimal conditions for successful tissue healing in the resection area.

Keywords: kidney, kidney resection, hemostasis, hemostatic suture, numerical simulation, method of finite elements, tissue healing
p. 320-325 of the original issue
References
  1. Aivazian AV. Gemostaz pri operatsiiakh na pochke [Hemostasis in the kidney surgery]. Moscow, USSR: Nauka. 1982. 280 p.
  2. Aliaev IuG, Krapivin AA. Rezektsiia pochki pri rake [Resection of kidney cancer]. Moscow, RF: Meditsina, 2001. 224 p.
  3. Kazimirov VG, Butrin SV. Anatomo-funktsional'noe obosnovanie rezektsii pochki [Anatomical and functional justification of nephrectomy]. Volgograd: Izdatel', 2011. 168 p.
  4. Kural AR, Demirkesen O, Onal B, Obek C, Tunc B, Onder AU, Yalcin V, Solok V. Outcome of nephron-sparing surgery: elective versus imperative indications. Urol Int. 2003;71(2):190-96.
  5. Pavlov VN, Kazikhinurov AA, Safiullin RI, Pushkarev AM, Mustafin AT, Nazmutdinova RG, Korzhavin V, Cakhautdinov DA, Garaev RR. Primenenie allotransplantata s tsel'iu gemostaza pri operatsiiakh na pochke [Use of the allograft for hemostasis purpose during operations on the kidney]. Med Vestn Bashkortostana. 2001;(1)6:91-94.
  6. Matveev VB, Matveev BP, Volkova MI, Perlyn DV, Fyguryn KM. Rol' organosokhraniaiushchego khirurgicheskogo lecheniia raka pochki na sovremennom etape [The role organ preservation surgery of kidney cancer at the present stage]. Onkourologiia. 2007;(2):5-11
  7. Vahidi B, Fatouraee N.A biomechanical simulation of ureteral flow during peristalsis using intraluminal morphometric data. J Theor Biol. 2012 Apr 7;298:42-50. doi: 10.1016/j.jtbi.2011.12.019.
  8. Frank K, Lindenborn H, Dahlhaus D. Numerical and experimental characterization of radiofrequency ablation in perfused kidneys. Conf Proc IEEE Eng Med Biol Soc. 2012;2012:5707-11. doi: 10.1109/EMBC.2012.6347291.
  9. Wimmer T, Srimathveeravalli G, Gutta N, Ezell PC, Monette S, Maybody M, Erinjery JP, Durack JC, Coleman JA, Solomon SB. Planning irreversible electroporation in the porcine kidney: are numerical simulations reliable for predicting empiric ablation outcomes? Cardiovasc Intervent Radiol. 2015 Feb;38(1):182-90. doi: 10.1007/s00270-014-0905-2.
  10. Zorbas G, Samaras T. Simulation of radiofrequency ablation in real human anatomy. Int J Hyperthermia. 2014 Dec;30(8):570-8. doi: 10.3109/02656736.2014.968639.
  11. Weinberg K, Ortiz M.Kidney damage in extracorporeal shock wave lithotripsy: a numerical approach for different shock profiles. Biomech Model Mechanobiol. 2009 Aug; 8(4):285-99. doi: 10.1007/s10237-008-0135-0.
  12. Farshad M, Barbezat M, Flüeler P, Schmidlin F, Graber P, Niederer P. Material characterization of the pig kidney in relation with the biomechanical analysis of renal trauma. J Biomech. 1999 Apr;32(4):417-25.
  13. Fovargue DE, Mitran S, Smith NB, Sankin GN, Simmons WN, Zhong P. Experimentally validated multiphysics computational model of focusing and shock wave formation in an electromagnetic lithotripter. J Acoust Soc Am. 2013 Aug;134(2):1598-609. doi: 10.1121/1.4812881.
  14. Snedeker JG, Barnstuble BB, Iaizzo PA, Farshad M, Niederer P, Schmidlin FR. A comprehensive renal injury concept based on a validated finite element model of the human abdomen. J Trauma. 2007 May;62(5):1240-49.
  15. Popkov VM, Ponukalin AN, Potapov DIu, Malysheva Iu A. Eksperimental'noe obosnovanie gemostaticheskikh shvov pri rezektsii pochki po povodu opukholi [Experimental justification of hemostatic sutures during partial nephrectomy for tumors]. Onkourologiia. 2012;(4):15-22.
Address for correspondence:
410012, Rossiyskaya Federatsiya,
g. Saratov, ul. B. Kazachya d. 112,
GBOU VPO "Saratovskiy gosudarstvennyiy
meditsinskiy universitet
im. V.I. Razumovskogo," kafedra urologii,
tel.: 7 927 104-80-68,
e-mail: potapovmed@rambler.ru,
Potapov Dmitriy Yurevich
Information about the authors:
Popkov V.M. MD, professor, Rector of HBEE HPE "Saratov State Medical University named after V.I. Razumovsky", a head of the urology chair.
Potapov D.Y. PhD, a surgeon, clinical hospital named after S.R. Mirotvortsev of "Saratov State Medical University named after V.I. Razumovsky".
Ponukalin A.N. PhD, an associate professor of the urology chair of "Saratov State Medical University named after V.I. Razumovsky".
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