Volume 52, Issue 4, Pages 1164-1169 (October 2007) Reducing Warm Ischaemia Time During Laparoscopic Partial Nephrectomy: A Prospective Comparison of Two Renal Closure Techniques  Hervé Baumert, Andrew Ballaro, Nimish Shah, Dhouha Mansouri, Nauman Zafar, Vincent Molinié, David Neal  European Urology  Volume 52, Issue 4, Pages 1164-1169 (October 2007) DOI: 10.1016/j.eururo.2007.03.060 Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 1 Schematic diagram showing steps of operative technique in group 1a. (1) Tumour excision, (2) first running suture on the tumour bed, (3) unclamping of the renal artery, (4) second haemostatic running suture, (5) tissue adhesive application, (6) parenchyma closure over a Surgicel bolster. European Urology 2007 52, 1164-1169DOI: (10.1016/j.eururo.2007.03.060) Copyright © 2007 European Association of Urology Terms and Conditions

Fig. 2 (1) Upper pole partial nephrectomy, for a 3-cm tumour, using cold scissors. (2) First 2-0 Vicryl running suture to close the collecting system and achieve haemostasis in the same time. (3) Removal of the bulldog clamp, in this case after 10min of warm ischaemia time. (4) Second 2-0 Vicryl running suture to improve haemostasis on the vascularised kidney. Note the slight bleeding during this step. In this case estimated blood loss was 100 cc. If necessary, extra sutures can be applied to visibly bleeding vessels before parenchyma closure. (5) FloSeal* is applied to improve haemostasis. (6) Closure of the parenchyma over a surgical bolster. European Urology 2007 52, 1164-1169DOI: (10.1016/j.eururo.2007.03.060) Copyright © 2007 European Association of Urology Terms and Conditions