The efficacy of modified binding technique for renorrhaphy during robotic partial nephrectomy: surgical and functional outcomes from single-center experience
-
Published:2022-08-18
Issue:1
Volume:37
Page:391-401
-
ISSN:0930-2794
-
Container-title:Surgical Endoscopy
-
language:en
-
Short-container-title:Surg Endosc
Author:
Wang Zhi-Yu, Zhang Wei, Yu Shuan-Bao, Zhan Yong-Hao, Fan Ya-Feng, Zhang Xue-PeiORCID
Abstract
Abstract
Background
To compare the traditional single-layer and double-layer suture renorrhaphy with modified “Binding” suture renorrhaphy (whole rim of the wound was closed by the all-layer flow suture starting from the parenchyma cut edges to hilum, followed by the final defect closure) in robotic partial nephrectomy (RPN) for treating localized renal cell carcinoma in our large institutional experience.
Methods
We retrospectively reviewed clinical data of 406 consecutive patients who underwent RPN from May 2018 and December 2020 in our center. The demographic and oncologic outcome variables were compared between different renal reconstruction groups and the effect of these suture techniques on renal function outcomes was also evaluated.
Results
For the single-layer group, median operative time and warm ischemic time were significantly less than that of the double-layer and “Binding” groups (p < 0.001), while the significantly lower eGFR drop (p = 0.014) was also detected within postoperative 3 months from baseline, but this difference lost its statistical significance from 3th month to the last follow-up. The changes in postoperative creatinine values were clinically insignificant among the three groups. In a sub-analysis over 258 patients with moderate/high nephrometry score, those patients who underwent “Binding” suture had an undifferentiated warm ischemic time, estimated blood loss, and length of hospitalization stay with a decreased risk of Grade III complications (postoperative hemorrhage requiring intervention) and improved renal function recovery during the whole follow-up.
Conclusion
Single-layer suture renorrhaphy may be associated with better renal functional preservation and could prove to be reliable in patients with low-complexity tumor (RENAL score ≤ 6). Patients with moderate/high-complexity tumor (RENAL score ≥ 7) might represent a subgroup of patients having a functional benefit after “Binding” suture renorrhaphy even in the long-term period.
Graphical abstract
Funder
Startup Research Fund of Zhengzhou University
Publisher
Springer Science and Business Media LLC
Reference27 articles.
1. Campbell S, Uzzo RG, Allaf ME, Bass EB, Cadeddu JA, Chang A, Clark PE, Davis BJ, Derweesh IH, Giambarresi L, Gervais DA, Hu SL, Lane BR, Leibovich BC, Pierorazio PM (2017) Renal mass and localized renal cancer: AUA guideline. J Urol 198:520–529 2. Ljungberg B, Bensalah K, Canfield S, Dabestani S, Hofmann F, Hora M, Kuczyk MA, Lam T, Marconi L, Merseburger AS, Mulders P, Powles T, Staehler M, Volpe A, Bex A (2015) EAU guidelines on renal cell carcinoma: 2014 update. Eur Urol 67:913–924 3. Borghesi M, Schiavina R, Gan M, Novara G, Mottrie A, Ficarra V (2013) Expanding utilization of robotic partial nephrectomy for clinical T1b and complex T1a renal masses. World J Urol 31:499–504 4. Kardos SV, Gross CP, Shah ND, Schulam PG, Trinh Q-D, Smaldone MC, Sun M, Weight CJ, Sammon J, Han LC, Kim SP (2014) Association of type of renal surgery and access to robotic technology for kidney cancer: results from a population-based cohort. BJU Int 114:549–554 5. Patel HD, Mullins JK, Pierorazio PM, Jayram G, Cohen JE, Matlaga BR, Allaf ME (2013) Trends in renal surgery: robotic technology is associated with increased use of partial nephrectomy. J Urol 189:1229–1235
Cited by
1 articles.
订阅此论文施引文献
订阅此论文施引文献,注册后可以免费订阅5篇论文的施引文献,订阅后可以查看论文全部施引文献
|
|