Abstract
Purpose: To compare surgical outcomes based on two reconstruction methods, including single-layer and double-layer renorrhaphy, in robot-assisted laparoscopic partial nephrectomy (RAPN) performed by an experienced surgeon.
Methods: We included 655 patients who underwent RAPN between January 2019 and June 2023. Patients with multiple tumors or insufficient medical records were excluded; therefore, 554 patients were analyzed. Surgical outcomes were compared between single-layer renorrhaphy (outer cortical closure) and double-layer renorrhaphy (inner layer suture and outer cortical closure) after adjusting for the preoperative factors, such as sex, age, BMI, ASA score, preoperative eGFR, preoperative complications of diabetes or hypertension, surgical approach (transperitoneal or retroperitoneal), tumor size, and tumor complexity, using propensity score matching.
Results: Of 554 patients, 59 were classified into the single-layer group and 495 into the double-layer group. Before matching, more complicated and larger tumors were included in the double-layer group. After matching, 58 patients were included in each group. The single-layer group showed significantly shorter operative time (91 min vs. 100 min, P=0.0361), lower EBL (7.9 ml vs. 27 ml, p=0.021), and better preservation of the eGFR (-1.2% vs. -5.1%, p=0.0313). Other outcomes, such as perioperative complications and postoperative hospital stay, were not significantly different between the two groups.
Conclusions: This study revealed that single-layer reconstruction resulted in better surgical outcomes in terms of the operative time, EBL, and preservation of kidney function. Single-layer reconstruction may optimize RAPN in selected patients.