Richard E. Link, MD, PhD, presented “Can You Drive a Stick? Prevention and Management of Bleeding During Minimally Invasive Renal Surgery” during the Innovations in Urologic Practice 2020 virtual conference in September 2020.
How to cite: Link, Richard E. “Can You Drive a Stick? Prevention and Management of Bleeding During Minimally Invasive Renal Surgery.” September 26th, 2020. Accessed Jul 2024. https://grandroundsinurology.com/can-you-drive-a-stick-prevention-and-management-of-bleeding-during-minimally-invasive-renal-surgery/
Can You Drive a Stick? Prevention and Management of Bleeding During Minimally Invasive Renal Surgery – Summary
Richard E. Link, MD, PhD, Professor of Urology and the Carlton-Smith Endowed Chair in Urologic Education at the Baylor College of Medicine, discusses techniques for preventing and managing bleeding during renal surgery, emphasizing the importance of maintaining laparoscopic surgery skills that have eroded with the increased use of robotic surgery. He explains that major bleeding complications can occur during abdominal access, critical dissection steps, or during exit from the abdomen, and surgeons need to be prepared with the correct tools and skills. Dr. Link presents a two-phase system for assessing danger and formulating a plan when major bleeding occurs. Phase 1 is short-term damage control, and involves evaluation of blood loss potential, determination of whether the blood is venous or arterial in origin, and a decision on whether the surgeon can handle the bleed laparoscopically with their skill set. Phase 2 is permanent control, and features a reassessment of response to damage control and a decision on whether the bleed can be solved laparoscopically or if the surgeon should facilitate safe open conversion. Adequate assessment is key to proper management. Dr. Link explains that robotic cases should be approached similarly, but emphasizes the importance of good teamwork and being slow and deliberate when there is a bleed during a robotic surgery.
About the Innovations in Urologic Practice 2020 virtual conference:
Presented by co-chairs Mohit Khera, MD, MBA, MPH, and Michael Coburn, MD, FACS, the Innovations in Urologic Practice conference provides a detailed review and commentary on multiple genitourinary and urologic diseases. Among the featured oncological topics are bladder cancer and immunotherapies, as well as upper tract cancer management, prostate cancer, including state-of-the-art imaging, focal therapy, and MRI. Experts also discuss new tools and techniques for nephrectomy and treating advanced renal cell carcinoma. In terms of general urological approaches, the conference also includes pelvic reconstruction and trauma, men’s health topics like male infertility and sexual dysfunction, and ways to diagnose and treat infections in the urology patient. Dr. Link presented this talk virtually at the 2020 conference.
ABOUT THE AUTHOR
Richard E. Link, MD, PhD, is a professor and board-certified and fellowship-trained urologist specializing in the treatment of urologic disease affecting the kidney, ureter, adrenal gland and prostate. Dr. Link holds the Carlton-Smith Endowed Chair in urologic education at the Baylor College of Medicine (BCM) in Houston, Texas and directs the BCM division of endourology and minimally invasive surgery. He serves as director of living donor procurement for several major kidney transplant programs in Houston, including Baylor St. Luke’s Medical Center, Texas Children’s Hospital, and the Houston Methodist Hospital. Dr. Link focuses on the use of laparoscopic, robotic-assisted, percutaneous, and endoscopic techniques to treat kidney and prostate tumors, benign prostatic hypertrophy, renal and ureteral obstruction, and urinary tract stones and has been an early pioneer in the development of laparoendoscopic single-site donor nephrectomy.
Dr. Link earned both his MD and PhD in molecular and cellular physiology at Stanford University in California and completed an internship and residency at BCM before completing a fellowship at The Johns Hopkins University School of Medicine in Baltimore, Maryland. Dr. Link also has a strong interest in applying single site robotic technology using the da Vinci SP platform to retroperitoneal and transvesical urologic surgery. He has published numerous papers and earned many awards, including the Fulbright and Jaworski LLP Faculty Excellence Award for Teaching and Evaluation at BCM.
