Comparison of Sutureless Versus Suture Partial Nephrectomy for Clinical T1 Renal Cell Carcinoma: A Meta-Analysis of Retrospective Studies

Abstract

BackgroundPartial nephrectomy (PN) is the recommended treatment for T1 renal cell carcinoma (RCC). Compared with suture PN, sutureless PN reduces the difficulty and time of operation, but the safety and feasibility have been controversial. This meta-analysis was conducted to compare the function and perioperative outcomes of suture and sutureless PN for T1 RCC.MethodsSystematic literature review was performed up to April 2021 using multiple databases to identify eligible comparative studies. According to the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) criteria, identification and selection of the studies were conducted. Meta-analysis was performed for studies comparing suture to sutureless PN for both T1a and T1b RCC. In addition, subgroup analysis was performed on operation time, warm ischemia time, estimated blood loss, and postoperative complications. Sensitivity analysis was used in analysis with high heterogeneity (operation time and estimated blood loss).ResultsEight retrospective studies were included with a total of 1,156 patients; of the 1,156 patients, 499 received sutureless PN and 707 received suture PN. The results showed that sutureless PN had shorter operative time (I2 = 0%, P < 0.001), warm ischemia time (I2 = 97.5%, P < 0.001), and lower clamping rate (I2 = 85.8%, P = 0.003), but estimated blood loss (I2 = 76.6%, P = 0.064) had no difference. In the comparison of perioperative outcomes, there was no significant difference in postoperative complications (I2 = 0%, P = 0.999), positive surgical margins (I2 = 0%, P = 0.356), postoperative estimated glomerular filtration rat (eGFR) (I2 = 0%, P = 0.656), and tumor recurrence (I2 = 0%, P = 0.531).ConclusionsIn T1a RCC with low RENAL score, sutureless PN is a feasible choice, whereas it should not be overestimated in T1b RCC.

From Sutureless to Standard: A Comprehensive Analysis of Conversion Rates in Laparoscopic Partial Nephrectomy

“…The thulium laser, precise and minimally damaging, is ideal for delicate kidney resections, while argon beam coagulation effectively coagulates larger bleeding areas [5][6][7][8][9][10]. These technologies reduce WIT, crucial for protecting renal function, especially in small T1a tumors, and can shorten surgical time and reduce blood loss, improving safety and effectiveness [11][12][13].…”

“…Sutureless Partial Nephrectomy (SLPN) leverages cutting-edge surgical technologies, including hemostatic agents and sealants, to achieve optimal hemostasis and parenchymal reconstruction without traditional sutures [5][6][7][8][9][10]. This innovative approach aims to reduce warm ischemia time, minimize blood loss, and potentially hasten postoperative recovery, thereby lowering the risk of complications such as parenchymal damage and pseudoaneurysms [11][12][13].…”

The Outcome of Sutureless in Partial Nephrectomy: A Systematic Review and Meta-Analysis

“…Indeed, two previous meta-analyses reported that single-layer suture versus double-layer suture did have better perioperative outcomes and less renal function loss [ 5 , 6 ], so it is reasonable to believe that sutureless will be a worthwhile surgical technique to develop. A recent meta-analysis was conducted, which compared suture and sutureless during renorrhaphy [ 13 ]. However, the definition of suture was not clear in this paper, including single-layer suture and double-layer suture, which may increase heterogeneity and lead to inaccurate results.…”