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

Abstract

Purpose. To compare the effect of sutureless versus standard suture (double-layer suture) during renorrhaphy in laparoscopic or robotic-assisted partial nephrectomy on perioperative and renal function outcomes. Methods. PubMed, Embase, and other sources were searched for randomized controlled trials or retrospective studies comparing sutureless partial nephrectomy versus standard suture partial nephrectomy. A systematic review and meta-analysis were performed by two reviewers independently. Results. Five retrospective studies were included with a total of 634 patients. The results showed that there was a significant difference in the decline of estimated glomerular filtration rate ( I 2 = 98.5 % ; WMD, -4.19 ml/min; 95% CI, -7.64 to -0.73; P < 0.001 ) and no significant difference in postoperative complications ( I 2 = 0 ; RR, 1.31; 95% CI, 0.61 to 2.81; P = 0.623 ). A significant advantage in terms of operating time ( I 2 = 53.9 % ; WMD, -29.08 min; 95% CI, -33.06 to -25.10; P = 0.069 ) and warm ischemia time ( I 2 = 38.5 % ; WMD, -6.17 min; 95% CI, -6.99 to -5.36; P = 0.165 ) favored sutureless, while there was no significant difference in blood loss ( I 2 = 58.1 % ; WMD, 3.10 ml; 95% CI, -39.18 to 45.38; P = 0.049 ). Conclusion. Sutureless during renorrhaphy is feasible and safe compared with standard suture. Sutureless can shorten the operating time and warm ischemia time without increasing postoperative complications, and thus, it protects renal function.

The Evolution of Tumor Enucleation Partial Nephrectomy: A Comparison of Perioperative Outcomes for Sutureless Hemostatic Bandage as an Alternative to Standard Renorrhaphy

“…Indeed, these results verify and add to data by other groups around the world investigating novel approaches to maximal renal function preservation. A meta-analysis assessing the literature for surgical outcomes when attempting sutureless PN by Liu and colleagues showed that using this approach had a smaller decline in eGFR, no signi cant difference in post-operative complications, shorter operative time and warm ischemia time, and no signi cant blood loss difference or rates of urine leak when compared to SR. (15) The meta-analysis included both robotic and laparoscopic studies but was reassuring as the outcomes assessed are some of the rst concerns that come to mind when considering the use of a sutureless approach.…”

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

“…For instance, bipolar and monopolar coagulation minimize intraoperative bleeding by coagulating tissue and sealing blood vessels. 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].…”

“…The stable conversion rates observed in our study also indirectly emphasize the low learning threshold of the sutureless technique, which seems to be unrelated to the surgeon's experience. This may be due to the intuitive operation process and fewer steps involved in the sutureless technique, thereby reducing the time and experience required to learn and master it [9,10]. Moreover, the simpli cation of the technique might also reduce the reliance on advanced skills of surgeons, allowing even less experienced surgeons to perform the surgery safely and effectively.…”

“…Partial Nephrectomy (PN) has become the preferred treatment for renal masses ≤ 7 cm, especially bene cial for patients with preexisting chronic kidney conditions, as it reduces the risk of chronic renal insu ciency and cardiovascular mortality [3,4]. 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].…”

Outcomes and Techniques of Robotic-Assisted Partial Nephrectomy (RAPN) for Renal Hilar Masses: A Comprehensive Systematic Review

“…A newer renorrhaphy technique, which involves the use of sliding clips instead of knots, has offered quicker renal suturing, a reduced learning curve, and a decrease in the "cheese-cutting effect" [104]. The common contemporary renorrhaphy technique typically consists of two tiers of suturing: a deeper layer at the excision site and a shallower layer [96,101,[105][106][107][108][109][110]. However, in the case of larger defects, achieving complete reapproximation of the capsule may be challenging, particularly when dealing with hilar renal masses to prevent compression of the renal hilum [111][112][113].…”