Single-Site Sutureless Partial Nephrectomy for Small Exophytic Renal Tumors

Abstract

Partial nephrectomy (PN) is the standard procedure for most patients with localized renal cancer. Laparoscopy has become the preferred surgical approach to target this cancer, but the steep learning curve with laparoscopic PN (LPN) remains a concern. In LPN intracorporeal suturing, the operation time is further extended even under robot assistance, a step which prolongs warm ischemic time. Herein, we shared our experience to reduce the warm ischemia time, which allows surgeons to perform LPN more easily by using a combination of hemostatic agents to safely control parenchymal bleeding. Between 2015 and 2018, we enrolled 52 patients who underwent LPN in our hospital. Single-site sutureless LPN and traditional suture methods were performed in 33 and 19 patients, respectively. Preoperative, intra-operative, and postoperative variables were recorded. Renal function was evaluated by estimated glomerular filtration rate (eGFR) pre- and postoperatively. The average warm ischemia time (sutureless vs. suture group; 11.8 ± 3.9 vs. 21.2 ± 7.2 min, p < 0.001) and the operation time (167.9 ± 37.5 vs. 193.7 ± 42.5 min, p = 0.035) were significantly shorter in the sutureless group. In the sutureless group, only 2 patients suffered from massive urinary leakage (>200 mL/day) from the Jackson Pratt drainage tube, but the leakage spontaneously decreased within 7 days after surgery. eGFR and serum hemoglobin were not found to be significantly different pre- and postoperatively. All tumors were removed without a positive surgical margin. All patients were alive without recurrent tumors at mean postoperative follow-ups of 29.3 ± 12.2 months. Single-site sutureless LPN is a feasible surgical method for most patients with small exophytic renal cancer with excellent cosmetic results without affecting oncological results.

Diagnostic Value of Color Doppler Ultrasound Combined with Superb Microvascular Imaging in the Detection of Small Renal Tumors Less than 3 cm Treated with Jinkui Shenqi Pills

“…Small renal tumors including benign and malignant tumors refer to intrarenal tumors less than 3 cm in diameter, and common benign tumors include angiomyolipoma [16][17][18][19]. Besides, malignant renal tumors, also known as renal cell carcinoma, commonly include Wilms' tumors and transitional cell carcinoma.…”

The Application of R.E.N.A.L. Nephrometry Score In Laparoscopic Partial Nephrectomy With Zero Ischemia And Sutureless

“…According to related research (23) and practice, traditional laparoscopic surgery has been improved, and it is proved that zero ischemia (18,24) and sutureless (25)(26)(27) LPN technique is feasible for the treatment of small, exogenous and peripheral RCC. Compared with the traditional renal artery occlusion, there is no signi cant difference in the sample statistics of IBL.…”

Comparison of Sutureless Versus Suture Partial Nephrectomy for Clinical T1 Renal Cell Carcinoma: A Meta-Analysis of Retrospective Studies

“…In recent years, some urologists have been focused on sutureless PN and tried to prove its safety and feasibility (2,(8)(9)(10)(11)(12)(13)(14)(15)(16)(17). Without suture, the difficulty of operation is reduced, and the operation time is saved.…”