Reconstruction Techniques After Partial Nephrectomy: Classic vs. Sutureless Approach—A Narrative Review

Moreno Cortés, J. C.; González García, J.; Caño Velasco, J.; Aragón Chamizo, J.; Subirá Rios, D.

doi:10.1007/s11934-023-01194-1

Cited by 2 publications

(3 citation statements)

References 22 publications

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“…In recent years, nephron-sparing surgery, particularly robot-assisted radical nephrectomy (RAPN), has emerged as a widely adopted treatment modality for patients with a renal mass < 7 cm in size, chronic kidney disease, or bilateral renal tumors. It is deemed technically feasible owing to its ability to better preserve renal function [1][2][3][4][5]. Although radical nephrectomy improves oncological outcomes in patients with renal cell carcinoma (RCC), its utility remains controversial as it results in the substantial loss of nephron tissue, potentially contributing to increased morbidity from chronic kidney disease, mortality from cardiovascular disease, and decreased overall survival [6,7].…”

Section: Introductionmentioning

confidence: 99%

“…RAPN is a surgical technique aimed at achieving a "trifecta" outcome, defined as (I) negative surgical margins, (II) maximum preservation of normal renal parenchyma, and (III) complete recovery without perioperative complications [1,3]. Similarly, renorrhaphy is a key process in achieving adequate hemostasis and renal reconstruction within an acceptable warm ischemic time during RAPN [6].…”

Section: Introductionmentioning

confidence: 99%

“…(2) single inner-layer renorrhaphy (SILR) with early unclamping [5], (3) double-layer renorrhaphy (DLR) [9], and (4) coagulation of the base following the removal of the renal tumor and sutureless renal parenchyma [1]. Nevertheless, parenchymal reconstruction by renorrhaphy may damage the renal artery branches and affect perirenal blood flow, resulting in irreversible ischemic changes in the remaining normal renal parenchyma [6].…”

Section: Introductionmentioning

confidence: 99%

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Impact of Robotic-Assisted Partial Nephrectomy with Single Layer versus Double Layer Renorrhaphy on Postoperative Renal Function

Ito,

Nakane,

Hagiwara

et al. 2024

Current Oncology

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We aimed to investigate the differences in renal function between patients who underwent single inner-layer renorrhaphy (SILR) or double-layer renorrhaphy (DLR) among those with renal tumors who underwent robot-assisted partial nephrectomy (RAPN). This retrospective multicenter cohort study was conducted between November 2018 and October 2023 at two institutions and included patients who underwent RAPN. In total, 93 eligible patients who underwent RAPN were analyzed. Preoperative renal function and prevalence of chronic kidney disease were not significantly different between the two groups. Although urinary leakage was observed in three patients (5.9%) in the SILR group, there was no significant difference between the two groups regarding surgical outcomes (p = 0.249). Serum creatinine levels after RAPN were significantly lower in the SILR group than in the DLR group on postoperative days 1 and 365 following RAPN (p = 0.04). The estimated glomerular filtration rate (eGFR) was significantly lower in the DLR group than in the SILR group only on postoperative day 1; however, there was no significant difference between the two groups thereafter. Multivariate analysis showed that the method of renorrhaphy was not a predictor for maintaining renal function after RAPN even though it was associated with eGFR on postoperative day 1.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Impact of Robotic-Assisted Partial Nephrectomy with Single Layer versus Double Layer Renorrhaphy on Postoperative Renal Function

Ito,

Nakane,

Hagiwara

et al. 2024

Current Oncology

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Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and Technique

Franco,

Riolo,

Tema

et al. 2024

Diagnostics

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The aim of our study is to evaluate the effectiveness and safety of a sutureless off-clamp robot-assisted partial nephrectomy (sl-oc RAPN), particularly its impact on renal function. A multicenter study was conducted from April 2021 to June 2022. Patients diagnosed with a renal mass of >2 cm and a PADUA score of ≤6 consecutively underwent an sl-oc RAPN procedure. Tumor features, patients characteristics, and intraoperative outcomes were assessed. An evaluation of renal function was performed preoperatively, and again at 1 and 3 months after surgery by measuring the creatinine and blood urea nitrogen levels. The renal function of the two separate kidneys was assessed by a sequential renal scintigraphy performed before and at least 30 days after surgery. A total of 21 patients underwent an sl-oc RAPN. The median age was 64 years (IQR 52/70), the median tumor diameter was 40 mm (IQR 29/45), and the median PADUA score was 4 (3.5/5). The intraoperative outcomes included operative time (OT), 90 (IQR 74/100) min; estimated blood loss (EBL), 150 (IQR 50/300) mL; and perioperative complications, CD > 3 1(5%); only two patients presented positive surgical margins in their final histology (2/21, 10%). Compared to the preoperative value, a decrease in renal function was highlighted with a statistically significant median decrease of 10 mL/min (p < 0.01). The renal scintigraphy showed an overall decrease in renal function compared to the preoperative value, with a range in the operated kidney that varied from 0 to 15 mL/s and from 0% to 40%, with a median value of 4 mL/s and 12%. sl-oc RAPN is a safe procedure, with a minimal impact on kidney function alteration. This technique has proven effective in preserving renal function and maintaining optimal oncological outcomes with limited complications.

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Reconstruction Techniques After Partial Nephrectomy: Classic vs. Sutureless Approach—A Narrative Review

Cited by 2 publications

References 22 publications

Impact of Robotic-Assisted Partial Nephrectomy with Single Layer versus Double Layer Renorrhaphy on Postoperative Renal Function

Impact of Robotic-Assisted Partial Nephrectomy with Single Layer versus Double Layer Renorrhaphy on Postoperative Renal Function

Renal Function Preservation in Purely Off-Clamp Sutureless Robotic Partial Nephrectomy: Initial Experience and Technique

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