V5-07: A Novel Technique of Non-Tissue Suturing Laparoscopic Partial Nephrectomy without the Renorrhaphy
Laparoscopic partial nephrectomy (LPN) has been commonly performed to spare as much as nephron mass, however, renal ischemic time is problematic. Furthermore, conventional suturing technique has potential to produce post-operative pseudo aneurysm and subsequent abrupt bleeding. We introduced a novel non-tissue suturing laparoscopic partial nephrectomy (NTS-LPN) and compared clinical outcomes with conventional laparoscopic partial nephrectomy (C-LPN) in our institution.
A hundred-eighty five patients who underwent partial nephrectomy since 2004 were divided between NTS-LPN group (NTS) (n=98) and C-LPN group (C) (n=87). The surgical maneuver of NTS differs with C after excising tumor with renal artery clamping. The resected surface was simply coagulated using a soft-coagulation system (a VIOTM system and an IO electrodeTM) without parenchyma suturing. After declamping, a TachoSil® is attached on coagulated surface. Perioperative data including the parenchymal volume of postoperative renal ischemic volume (PRIV) and the change of residual renal volume (RRV) calculated by 3D-CT volumetry, postoperative kidney function and adverse events were compared between 2 groups.
Mean operative time and renal ischemic time in NTS (146±34.0min/15.6±7.45min) were dramatically shortened as compared to those in C (236±77.8min/54.8±27.4min). Mean operative blood loss was similar between NTS (43.3±61.5ml) and C (65.9±91.9ml). Renal parenchymal damage as shown PRIV was significantly less in NTS group than that in C at the point of postoperative 3, 6, 12 months (NTS: 4.26±2.29ml, 2.37±1.02ml, 1.67±0.55ml / C: 19.4±5.49ml, 15.9±8.20ml, 13.1±6.00ml). Renal atrophy as shown RRV postoperative 3, 6, 12 months was also significantly less in NTS than that in C (p<0.01). No positive surgical margin was observed in NTS, but only one case in C. Serum creatinine values of each point (1/3/6/12 months) were comparable in both groups. According to Clavien-Dindo classification, major complications of IIIa (postoperative bleeding, minor urinary leakage and peri-renal abscess) were observed in C, whereas 2 cases of minor urinary leakage in NTS. In addition, 6 cases of pseudo aneurysm were only observed in C.</p>
A novel technique of NTS-LPS could spare operative and ischemic time and nephron loss as well without increasing invasiveness compared with conventional tissue-suturing partial nephrectomy.
Funding: The authors have no financial conflicts of interest to disclose concerning the presentation.