CASE 6 – Robotic Kidney Surgery “when coiling is not enough”
Man (54) – 1:9 ratio – slow controlled injection
We do not normally use glue when it comes to the kidneys because it is a terminal vascularization, but when coiling is not enough you may need different embolic material. This was a particularly difficult case as it presented multiple bleeding, and it just would not stop with simple coiling of the arteries, so I decided to switch to glue. It was important to handle the syringe with care because, when you deal with terminal arteries, it is very easy to get backflow. I used a sandwich technique with a very diluted mixture, inserting small boluses from the tip of the micro-catheter inside the cavity formed by the surgery and the hemorrhage. By handling the syringe with care I was able to inject a block of glue that formed sort of a film from which I could build up and successfully managed to completely embolize the vessel, while avoiding backflow. I could still see some residual bleeding from the coiling technique I had used before, and, although I was confident it would stop sooner or later, which it eventually did, I believe that if I had started with glue rather than coiling, I could have reached the goal much faster.