Comparison of perioperative outcomes with or without renorrhaphy during open partial nephrectomy: A propensity score-matched analysis

Abstract

Purpose:Renorrhaphy in partial nephrectomy may damage intraparenchymal vessels and compress the renal parenchyma, which may lead to the formation of renal artery pseudoaneurysms or vascularized parenchymal volume reduction. Using propensity score matching, we compared surgical outcomes following non-renorrhaphy and renorrhaphy techniques for open partial nephrectomy (OPN) for T1a renal tumors.Materials and Methods:We retrospectively analyzed data from 159 patients with normal contralateral kidneys who underwent OPN for T1a renal tumors and pre- and postoperative enhanced computed tomography between 2012 and 2015. Patient variables were adjusted using 1:1 propensity score matching between the two Groups: renorrhaphy (inner and outer layer sutures) and non-renorrhaphy (inner layer sutures only). Postoperative complications and renal function were compared between the two groups.Results:We matched 43 patients per Group. Operative time, estimated blood loss, cold ischemic time, and postoperative hospital stay were not significantly different between the two Groups. Urine leakage (Clavien-Dindo grade ≥3) occurred in 0 renorrhaphy cases and 2 non-renorrhaphy cases (0% versus 4.6%, P=0.49). Renal artery pseudoaneurysm (RAP) occurred in 6 renorrhaphy cases and in 0 non-renorrhaphy cases (13% versus 0%, P=0.02).Conclusions:The non-renorrhaphy technique may result in a lower risk of RAP but a greater risk of urine leakage. This technique needs further refinement to become a standard procedure for OPN.

Comparison of robot‐assisted partial nephrectomy with soft coagulation and double‐layer technique for complex and non‐complex tumors

“…Tachibana et al found that the risk of pseudoaneurysm was lower with SLT than with DLT during open partial nephrectomy. 18 Similarly, in patients undergoing RAPN for cT1a disease, the risk of pseudoaneurysm was lower when SLT with soft coagulation was used. [4][5][6][7] Early unclamping may help prevent pseudoaneurysm after partial nephrectomy because Kondo et al reported that early unclamping allowed surgeons to identify arterial bleeding from the resection bed before suturing the renal parenchyma and control it by adding an internal suture.…”

“…Tachibana et al. found that the risk of pseudoaneurysm was lower with SLT than with DLT during open partial nephrectomy 18 . Similarly, in patients undergoing RAPN for cT1a disease, the risk of pseudoaneurysm was lower when SLT with soft coagulation was used 4–7 .…”

Natural history of asymptomatic renal artery pseudoaneurysm after robot-assisted partial nephrectomy

“…The soft coagulation system of the VIO 300D was used with the effect level set at 7 and output of 80 W, using a ball-type electrode to increase the contact area with the resection bed. Tachibana et al also showed that the non-renorrhaphy (inner layer sutures only) technique using the soft-coagulation system may produce a lower risk of RAP than renorrhaphy (inner and outer layer sutures) (19). Similarly, for RAPN in patients with cT1a renal tumors, RAP did not occur with hemostasis by soft coagulation only, namely with inner sutures and without outer sutures (20,21).…”

Mid-term outcome of transarterial embolization of renal artery pseudoaneurysm and arteriovenous fistula after partial nephrectomy screened by early postoperative contrast-enhanced CT

“…In addition, we are now largely reducing the contrast material and radiation exposure dose by using a full iterative reconstruction method, a forward-projected model-based iterative reconstruction solution (FIRST; Canon Medical Systems, Otawara, Japan), while improving the visualization of the peripheral renal arteries (Morita et al 2020 ). Furthermore, the frequency of RAP in our institution has recently decreased due to improvements in surgical techniques, such as early unclamping, avoidance of deep excision into the renal sinus, and the non-renorrhaphy technique (Omae et al 2015 ; Tachibana et al 2018 ; Kondo et al 2015 ). However, the management of RAPs after partial nephrectomy should be carefully considered, especially in non-high-volume centers, because they can lead to life-threatening complications.…”