Description of a multicenter safety checklist for intraoperative hemorrhage control while clamped during robotic partial nephrectomy

A treatment safety checklist for the management of hemorrhage during robotic partial nephrectomy was collaboratively developed based on prior experiences with intraoperative hemorrhage during robotic partial nephrectomy.Reducing the risk of hemorrhage during robotic partial nephrectomy begins with reviewing the preoperative imaging for renal vasculature and tumor anatomy, with a focus on accessory vessels and renal tumor proximity to the renal hilum. During hilar exposure, an attempt is made to identify additional accessory renal arteries. The decision is then made on whether to clamp the hilum (artery +/- vein). If bleeding is encountered during resection, management is based on whether the bleeding is suspected to be arterial or from venous backbleeding. Operative maneuvers that may increase the chance of success are highlighted in safety checklists for arterial and venous bleeding.Safely performing robotic partial nephrectomy is dependent on attention to prevention of hemorrhage and rapid response to the challenge of intraoperative bleeding. Preparation is essential for maximizing the chance of success during robotic partial nephrectomy.Hemorrhage during surgery is a patient safety concern and a source of stress for surgeons. During partial nephrectomy, in which part of the kidney is removed for a renal tumor, hemorrhage can be particularly troublesome because the kidney is a well perfused organ and renal cell carcinomas are associated with increased vascularity [1]. Traditionally, partial nephrectomy had been performed via an open approach but there has been a steady trend toward a minimally invasive approach [2].As partial nephrectomy is increasingly performed with a minimally invasive approach, control of intraoperative hemorrhage can be more challenging than simple manual compression of the renal parenchyma with suturing, as can be done in open surgery. Hemorrhage is further concerning as control can occupy valuable time during which the renal unit is ischemi