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