Renorrhaphy techniques and effect on renal function with robotic partial nephrectomy

Shatagopam, Kashyap; Bahler, Clinton D.; Sundaram, Chandru P.

doi:10.1007/s00345-019-03033-w

Cited by 29 publications

(11 citation statements)

References 26 publications

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“…Sutures for the closing of renal parenchyma defects during laparoscopic and robotic-assisted PN represent a standard technique and various approaches have been proposed [ 17 ]. However, adequate parenchymal tissue repair remains a challenging step during LPN, with putative detrimental results like intraoperative and postoperative bleeding, urinoma and infection, and also renal function impairment as a consequence of prolonged ischemia [ 9 ].…”

Section: Discussionmentioning

confidence: 99%

Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

et al. 2021

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Background Improvements in laparoscopic partial nephrectomy (LPN) in order to minimize perioperative warm ischemia time (WIT), complications, and consequently patient outcome are desirable. Veriset™ is a ready-to-use hemostatic patch of absorbable oxidized cellulose and hydrogel components that has earlier been implemented in vascular and hepatic surgery. We report our experience using this device in LPN. Methods Patients with a solitary malignant renal mass suspicious for renal cancer underwent LPN with either the use of Veriset™ hemostatic patch (n = 40) or conventional suture technique (n = 40). Patient characteristics, operation time and WIT, postoperative course and complications were recorded retrospectively. Tumor complexity was calculated according to the R.E.N.A.L. score. Outcome was determined according to the “trifecta” criteria (negative surgical margin, WIT < 25 min, no complications within 30 days). Results No significant differences with regard to clinical parameters and median R.E.N.A.L. score (6) were observed between both groups. Operation time (mean 127.1 min vs. 162. 8 min; p = 0.001) and WIT were both lower in the Veriset™ group (14.6 min vs. 20.6 min; p = 0.01). No differences in surgical margins (p = 0.602) and overall complication rates at 30 (p = 0.599) and 90 days (p = 0.611) postoperatively were noticed. The surgical outcome according to “trifecta” was achieved in 65% of patients using Veriset™ and in 57.5% of patients by suture closure, respectively. Conclusion The hemostatic Veriset™ patch can successfully be implemented in LPN. Handling and application appear favorable, thereby reducing operation time and WIT. The present results suggest that the device may represent an alternative to parenchyma suturing in LPN.

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Section: Discussionmentioning

confidence: 99%

Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

et al. 2021

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“…Additionally, the approach adopted for tumor removal, resection, or enucleation may influence the type of reconstruction performed. There was no consensus on the ideal approach for renorrhaphy during partial nephrectomy (40)(41)(42). Moreover, there was not much data on the impact of renorrhaphy on long-term renal function (41).…”

Section: Reconstruction: Medullary and Cortical Suturesmentioning

confidence: 99%

Recommendations and optimal approaches to robotic-assisted partial nephrectomy: A consensus of Brazilian experts

et al. 2023

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ObjectiveRobotic-assisted partial nephrectomy (RAPN) is established as the gold standard approach to treating small renal masses. However, numerous technical challenges and concepts related to this approach are still under discussion and are not consensus among surgeons from different centers. We performed an online questionnaire with multiple topics about RAPN and selected high-volume surgeons from referral centers in Brazil to achieve a consensus.MethodsWe implemented an online consensus of 29 experts selected based on surgical expertise and competence in analyzing the published literature. Based on the collected literature and current Guidelines (NCCN, AUA, and EAU) we created a questionnaire with 131 questions and administered it to all participants. The statements and the Delphi technique design were combined in a single round of questions. The answers were reviewed, 70% of concordance was considered a consensus, and a final manuscript with recommendations was developed.ResultsWe divided our results into 25 subtopics that included all questions and discussions of the questionnaire, including preoperative settings, surgical technique, pathological analysis, technology use, and challenging cases. Some areas had limited data in the literature, and these potential limitations were addressed and discussed on each topic.ConclusionRAPN is the standard surgical treatment for renal masses in the centers of robotic surgery. Among the important topics of this study, we recommend always performing the first RAPN cases with proctors’ assistance, conducting preoperative planning using good-quality imaging exams, minimizing the amount of renal parenchyma removed, and achieving appropriate hemostatic suture while reducing renal parenchyma ischemia.

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“…According to the available evidence and expert opinions, the cortical instead of the medullary layer should be omitted [42 ▪▪ ]. A randomized controlled trial assessing the impact of cortical renorrhaphy for T1 renal masses on the percentage of renal volume loss and postoperative renal function is ongoing (NCT02131376) [48 ▪▪ ].…”

Section: Renorrhaphy Techniques In Nephron-sparing Surgerymentioning

confidence: 99%

How to improve outcome in nephron-sparing surgery: the impact of new techniques

Cignoli

Fallara

Larcher

et al. 2021

Current Opinion in Urology

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Purpose of reviewNephron-sparing partial nephrectomy is the state of the art for localized small renal mass and it is gaining attention also for more advanced cases. In the present narrative review, we discuss the new developments that have occurred in the advancement of this approach over the past few years.Recent findingsOff-clamp, selective/superselective clamp and early-unclamping techniques are safe and feasible approaches, with potentially superior functional outcomes, and noninferior complications rate and oncological outcomes, when compared with main artery clamping. Renorrhaphy must preserve the physiological vascularization of residual parenchyma. Running sutures, particularly using barbed wires, shorten the operating and ischemia times. A further advantage could derive from avoiding a double-layer suture. Transperitoneal robot-assisted partial nephrectomy (RAPN) and retroperitoneal RAPN can be considered equivalent in terms of perioperative morbidity, functional and oncologic outcomes, regardless of tumor's location, thus the choice of the approach should be driven by the surgeon's expertise. Future improvements should be introduced by the single-port robotic surgery, which seems to be safe and feasibly also in an off-clamp manner.SummarySignificant advances have recently been achieved in nephron-sparing surgery technique. However, future studies with standardized reporting of these new techniques are needed to assess the real impact of them on early and long-term functional outcomes.

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Renorrhaphy techniques and effect on renal function with robotic partial nephrectomy

Cited by 29 publications

References 26 publications

Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

Versatility and clinical effectiveness of a synthetic sealing hemostatic patch as alternative to parenchyma suturing in laparoscopic partial nephrectomy

Recommendations and optimal approaches to robotic-assisted partial nephrectomy: A consensus of Brazilian experts

How to improve outcome in nephron-sparing surgery: the impact of new techniques

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