Introduction & objective: laparoscopic partial nephrectomy is rapidly emerging as a potential surgical option for select renal tumors. The most challenging aspect of the procedure is the effective hemostatic closure of the collecting system and the renal parenchyma. We present our modification of Shalhav’s technique to limit warm ischemia time during closure of the collecting system and suturing of the bolster in position during laparoscopic partial nephrectomy. With this approach, there is no passage of needles into the abdomen and only two sutures are used.
Methods: this video demonstrates the use of the LapraTy (Ethicon Endosurgery, Inc., Cincinnati, OH) absorbable suture clips to quicken the time to suture the collecting system and secure the bolster during a laparoscopic upper pole heminephrectomy for renal tumor. Prior to initiating warm ischemia, 2 sutures are placed in the abdomen. A 10-inch length of 0-Vicryl on a CT-1 needle for suturing the bolster and a 6-inch length of 2-0 Vicryl on a SH needle for closure of the collecting system. Each suture has a LapraTy clip affixed on the end. After the hilar vessels have been clamped and excision of the tumor has been performed with a Ligasure device, the parenchymal surface is treated with the Argon beam coagulator. Next, the collecting system is closed with the 6-inch suture; a layer of Floseal is applied. Then oxidized cellulose bolsters are placed into the renal parenchymal defect. Renorrhaphy is performed with the 10-inch suture and LapraTy clip. The needle is passed through one side of the edge of the incised renal parenchyma, over the bolster, and then out the opposite parenchymal edge. The suture is snugged down over the bolster and secured with 1 or 2 LapraTy clips. An additional LapraTy clip is placed ¼ inch from the last clip and the suture is cut between the two clips. The needle and suture with the LapraTy clip are now ready to repeat the suturing sequence to place another simple suture. A total of four sutures are placed in this manner, all with the same suture. As such, there is no passage of needles into the abdomen during warm ischemia.
Conclusion: this technique provides a rapid and effective hemostatic placement of the bolster during laparoscopic partial nephrectomy. To date, in ten procedures performed in this manner, there have been no complications of fistulas or bleeding.

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