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Daou S, Albeaini S, Mjaess G, Diamand R, Albisinni S, Roumeguère T, Aoun F. Renorrhaphy techniques in minimally invasive partial nephrectomy: a systematic review of the literature. Minerva Urol Nephrol 2023; 75:683-695. [PMID: 38126283 DOI: 10.23736/s2724-6051.23.05345-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2023]
Abstract
INTRODUCTION In the absence of consensus on the optimal approach to renorrhaphy in partial nephrectomy, this systematic review aims to assess the various renorrhaphy techniques and their impact on surgical outcomes. EVIDENCE ACQUISITION A systematic review of the literature was performed in March 2022, using PubMed and Scopus, without time restrictions and research filters for studies investigating renorrhaphy techniques in partial nephrectomy. Studies providing sufficient details on renorrhaphy techniques and their outcomes during minimally invasive partial nephrectomy (PN) were included in this analysis. EVIDENCE SYNTHESIS Thirty-one studies with 5720 patients were included in the analysis. In most studies, tumor diameter was <4 cm. RENAL and PADUA scores as well as tumor locations were heterogeneous between the studies. The results of the use of hemostatic agents were conflicting among different studies with limited evidence regarding the benefits of its routine use in partial nephrectomy. The use of barbed and running sutures was associated with a reduced warm ischemia time. While some studies showed a decreased warm ischemia time when omitting cortical renorrhaphy, others found that it may lead to higher incidence of minor complications without any significant improvement in other outcomes. CONCLUSIONS There is ongoing research to determine the optimal approach to renorrhaphy. The current evidence on the routine use of hemostatic agents is limited. The use of certain techniques such as barbed sutures, sliding clips and running sutures reduced the warm ischemia time. The omission of cortical renorrhaphy is still controversial.
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Affiliation(s)
- Samah Daou
- Faculty of Medicine, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon -
| | - Sylvana Albeaini
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Georges Mjaess
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Romain Diamand
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Simone Albisinni
- Unit of Urology, Department of Surgical Sciences, Tor Vergata University Hospital, Tor Vergata University of Rome, Rome, Italy
| | - Thierry Roumeguère
- Department of Urology, University Hospital of Brussels, Brussels, Belgium
| | - Fouad Aoun
- Faculty of Medicine, Hôtel-Dieu de France, Saint-Joseph University, Beirut, Lebanon
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Pan JW, Zhang X, Jin XW, Liu X, Tu WC, Wang XJ, Huang BX, Xu D, Lu GL, Wang DW, Wang XH, Shao Y. Needle Adjustment Free (NAF) running suture technique (PAN suture) in laparoscopic partial nephrectomy. BMC Surg 2021; 21:118. [PMID: 33676481 PMCID: PMC7937216 DOI: 10.1186/s12893-021-01112-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 02/09/2021] [Accepted: 02/21/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND It is proposed a new running suture technique called Needle Adjustment Free (NAF) technique, or PAN suture. The efficiency and the safety were evaluated in laparoscopic partial nephrectomy. METHODS This new running suture technique avoids the Needle Adjustment method used in traditional techniques. The new continuous suture technique (11 patients) was compared with the traditional continuous suture method (33 patients) used in both transperitoneal and retroperitoneal laparoscopic partial nephrectomy (LPN) in terms of suture time (ST), warm ischemia time (WIT), blood loss (BL), open conversion rate and post-op discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op). Differences were considered significant when P < 0.05. RESULTS ST in the PAN suture group was 30.37 ± 16.39 min, which was significant shorter (P = 0.0011) than in the traditional technique group which was 13.68 ± 3.33 min. WIT in the traditional technique group was 28.73 ± 7.89 min, while in the PAN suture group was 20.64 ± 5.04 min, P = 0.0028. The BL in entirety in the traditional technique group was 141.56 ± 155.23 mL, and in the PAN suture group was 43.18 ± 31.17 mL (P = 0.0017). BL in patients without massive bleeding in the traditional technique group was significantly greater than in the PAN suture group at 101.03 ± 68.73 mL versus 43.18 ± 31.17 mL (P = 0.0008). The open conversion rate was 0 % in both groups. There was no significant difference between the two groups in postoperative discharge time, post-op bleeding, post-op DVT, ΔGFR (affected side, 3 months post-op). CONCLUSIONS The NAF running suture technique, or PAN suture, leading to less ST, WIT and BL, which was shown to be more effective and safer than the traditional technique used for LPN. A further expanded research with larger sample size is needed.
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Affiliation(s)
- Jun-Wei Pan
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Xiang Zhang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Xing-Wei Jin
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Xiao Liu
- Department of Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Wei-Chao Tu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Xian-Jin Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Bao-Xing Huang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Da Xu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Guo-Liang Lu
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Da-Wei Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China
| | - Xiang-Hui Wang
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China.
| | - Yuan Shao
- Department of Urology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, No. 999, Xi Wang Road, Shanghai, 201801, China.
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Bukavina L, Mishra K, Calaway A, Ponsky L. Robotic Partial Nephrectomy: Update on Techniques. Urol Clin North Am 2020; 48:81-90. [PMID: 33218596 DOI: 10.1016/j.ucl.2020.09.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Surgical techniques for robot-assisted partial nephrectomy are driven by the aims of simplifying the most challenging surgical steps, maximizing functional and oncologic outcomes, and consistently pushing the envelope on possibilities. Over the past several years, we have seen an emergence in not only innovation in surgical technique, and robotic platforms, but integration of a variety of imaging techniques. We believe with developing robotic expertise, practicing urologists will continue to push the envelope in nephron preservation and complication-free recovery.
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Affiliation(s)
- Laura Bukavina
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Kirtishri Mishra
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Adam Calaway
- University Hospitals Cleveland Medical Center, Urology Institute, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Lee Ponsky
- Urology Institute, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, 11100 Euclid Avenue, Suite 411, Cleveland, OH 44106, USA.
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Favorito LA. Editorial Comment: Oncological and functional outcomes of open versus laparoscopic partial nephrectomy in T1b tumors: A single-center analysis. Int Braz J Urol 2020; 46:351-352. [PMID: 32167696 PMCID: PMC7088488 DOI: 10.1590/s1677-5538.ibju.2018.0865.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Luciano A Favorito
- Professor Associado da Unidade de Pesquisa Urogenital - Universidade do Estado de Rio de Janeiro - Uerj, Rio de Janeiro, RJ, Brasil.,Serviço de Urologia, Hospital Federal da Lagoa, Rio de Janeiro, RJ, Brasil
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Tensile force exerted by suture during renorrhaphy using current techniques. J Robot Surg 2019; 14:383-386. [PMID: 31301022 DOI: 10.1007/s11701-019-00999-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2019] [Accepted: 07/08/2019] [Indexed: 10/26/2022]
Abstract
Partial nephrectomy has become the preferred treatment option for small renal masses. In particular, minimally invasive partial nephrectomy (MIPN) using laparoscopic or robotic approaches has shown decreased blood loss, shorter hospital stay, and faster return to normal activity compared to open surgery. However, MIPN still carries risk of postoperative complications including hemorrhage and urine leakage. Closure of the renal remnant, often called renorrhaphy, is a critical step to avoid these complications. The purpose of the study was to provide quantitative data on suture properties during partial nephrectomy. Multiple suture techniques have been proposed for renal closure during robotic-assisted partial nephrectomy. There is no consensus for preferred closure technique and this decision is at the discretion of the surgeon. Simulated partial nephrectomies were performed on porcine kidneys. Renorrhaphy was completed with barbed suture using a simple running, interrupted sliding-clip, or horizontal mattress technique. Suture tension was obtained prior to tissue failure with force sensors measuring in newtons (N). The interrupted sliding-clip and horizontal mattress techniques performed similarly with median force values of 11.06 N and 12.20 N, respectively. The simple running technique performed with a median force of 3.62 N. ANOVA proved statistical significance. Interrupted sliding-clip and horizontal mattress sutures exert similar forces prior to tissue failure during renorrhaphy. Both techniques were able to achieve forces great enough to overcome the hydrostatic pressure of perfused renal tissue. Simple running sutures failed at significantly lower forces. When closing renal defects after partial nephrectomy, sliding-clip and horizontal mattress should be utilized over simple running sutures.
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Bertolo R, Campi R, Klatte T, Kriegmair MC, Mir MC, Ouzaid I, Salagierski M, Bhayani S, Gill I, Kaouk J, Capitanio U. Suture techniques during laparoscopic and robot-assisted partial nephrectomy: a systematic review and quantitative synthesis of peri-operative outcomes. BJU Int 2018; 123:923-946. [PMID: 30216617 DOI: 10.1111/bju.14537] [Citation(s) in RCA: 41] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri-operative outcomes after minimally invasive partial nephrectomy (MIPN). MATERIALS AND METHODS A systematic review of the literature was performed in January 2018 without time restrictions, using MEDLINE, Cochrane and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Studies providing sufficient details on renorrhaphy techniques during laparoscopic or robot-assisted partial nephrectomy and comparative studies focused on peri-operative outcomes were included in qualitative and quantitative analyses, respectively. RESULTS Overall, 67 and 19 studies were included in the qualitative and quantitative analyses, respectively. The overall quality of evidence was low. Specific tumour features (i.e. size, hilar location, anatomical complexity, nearness to renal sinus and/or urinary collecting system), surgeon's experience, robot-assisted technology, as well as the aim of reducing warm ischaemia time and the amount of devascularized renal parenchyma preserved represented the key factors driving the evolution of the renorrhaphy techniques during MIPN over the past decade. Quantitative synthesis showed that running suture was associated with shorter operating and ischaemia time, and lower postoperative complication and transfusion rates than interrupted suture. Barbed suture had lower operating and ischaemia time and less blood loss than non-barbed suture. The single-layer suture technique was associated with shorter operating and ischaemia time than the double-layer technique. No comparisons were possible concerning renal functional outcomes because of non-homogeneous data reporting. CONCLUSIONS Renorrhaphy techniques significantly evolved over the years, improving outcomes. Running suture, particularly using barbed wires, shortened the operating and ischaemia times. A further advantage could derive from avoiding a double-layer suture.
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Affiliation(s)
- Riccardo Bertolo
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Riccardo Campi
- Department of Urology, University of Florence, Florence, Italy
| | - Tobias Klatte
- Department of Urology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK
| | | | - Maria Carmen Mir
- Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain
| | - Idir Ouzaid
- Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France
| | - Maciej Salagierski
- Urology Department, Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland
| | - Sam Bhayani
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA
| | - Inderbir Gill
- Keck School of Medicine, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.,Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jihad Kaouk
- Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA
| | - Umberto Capitanio
- Division of Urology, Washington University School of Medicine, St Louis, MO, USA.,Keck School of Medicine, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA.,Department of Urology, San Raffaele Scientific Institute, Milan, Italy.,Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy
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