Bibliographic record
Abstract
Introduction and Objective:The incidence of renal cell carcinoma currently accounts for 3% of all adult malignancies, and is rising.The current gold standard treatment for most T1 renal masses is open partial nephrectomy (OPN).However, laparoscopic partial nephrectomy (LPN) has gained increased acceptance having shown equivalent results at 5year oncological and renal function outcomes.Unfortunately, data has shown an increased haemorrhage rate and longer ischemia time.We hypothesise that this is due to technical limitations.The inability to maintain tension on the running continuous suture during primary closure of the defect may result in higher postoperative bleeds.We present a new technique using a barbed tension retaining suture.The barbs allow for the suture to pass through tissue in one direction but not the other, therefore maintaining tension after being let go by the grasping forceps.Furthermore, removal of the renal hilar clamp prior to definitive management of the renal defect with bolstering sutures is theorized to decrease warm ischemia time without significantly compromising intraoperative hemostasis.This early unclamping might also allow the visualisation of smaller bleeding vessels which could then be directly controlled.The objective of these techniques is to decrease blood loss, postoperative haemorrhage rates and ischemia time in the LPN. Methods:We performed our technique in 16 consecutive LPN for T1 renal masses.In brief, we begin with dissection of the kidney and renal hilum as per the standard laparoscopic operation.A clamp is then applied en-block to the renal vessels.The mass is then removed en block using sharp dissection.Using a single bidirectional 0-PDO barbed suture the renal parenchyma is approximated, beginning with a single bite in the centre of the defect and working towards the ends of the defect until it is closed.Tension in the suture is maintained using 2 self locking clips on each end.The hilar clamp is then removed prior to placement of final bolstering sutures, with or without a biologic hemaostatic agent.Results: Mean maximal diameter of the 16 masses was 3.2 cm.Mean ischemia time was 12.7 minutes and blood loss was 122 cc.There were no complications and no reoperations. Conclusions:We have observed that our technique has increased the ease of operation and appears to aid with intraoperative haemostasis.Preliminary results demonstrate a decrease in ischemia time and postoperative bleeding.We have now adopted this method for all our open and laparoscopic partial nephrectomies.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.000 | 0.003 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.001 | 0.000 |
| Scholarly communication | 0.002 | 0.002 |
| Open science | 0.001 | 0.002 |
| Research integrity | 0.003 | 0.003 |
| Insufficient payload (model declined to judge) | 0.766 | 0.349 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".