The efficacy of modified binding technique for renorrhaphy during robotic partial nephrectomy: surgical and functional outcomes from single-center experience

Abstract

Background To compare the traditional single-layer and double-layer suture renorrhaphy with modified “Binding” suture renorrhaphy (whole rim of the wound was closed by the all-layer flow suture starting from the parenchyma cut edges to hilum, followed by the final defect closure) in robotic partial nephrectomy (RPN) for treating localized renal cell carcinoma in our large institutional experience. Methods We retrospectively reviewed clinical data of 406 consecutive patients who underwent RPN from May 2018 and December 2020 in our center. The demographic and oncologic outcome variables were compared between different renal reconstruction groups and the effect of these suture techniques on renal function outcomes was also evaluated. Results For the single-layer group, median operative time and warm ischemic time were significantly less than that of the double-layer and “Binding” groups (p < 0.001), while the significantly lower eGFR drop (p = 0.014) was also detected within postoperative 3 months from baseline, but this difference lost its statistical significance from 3th month to the last follow-up. The changes in postoperative creatinine values were clinically insignificant among the three groups. In a sub-analysis over 258 patients with moderate/high nephrometry score, those patients who underwent “Binding” suture had an undifferentiated warm ischemic time, estimated blood loss, and length of hospitalization stay with a decreased risk of Grade III complications (postoperative hemorrhage requiring intervention) and improved renal function recovery during the whole follow-up. Conclusion Single-layer suture renorrhaphy may be associated with better renal functional preservation and could prove to be reliable in patients with low-complexity tumor (RENAL score ≤ 6). Patients with moderate/high-complexity tumor (RENAL score ≥ 7) might represent a subgroup of patients having a functional benefit after “Binding” suture renorrhaphy even in the long-term period. Graphical abstract

Impact of Robotic-Assisted Partial Nephrectomy with Single Layer versus Double Layer Renorrhaphy on Postoperative Renal Function

“…The WIT and amount of healthy renal parenchyma resected are considered key determinants of renal function and renal parenchyma volume loss following RAPN [21]. Among these factors, the decline in renal function is believed to be primarily associated with the reduction in renal volume rather than the WIT [8]. With regard to renorrhaphy, which is performed to achieve hemostasis, the amount of healthy renal tissue incised to remove the tumor can vary [22,23].…”

“…Therefore, the amount of normal renal parenchyma, which contains a large number of vascular vessels, and the method of renorrhaphy can be major factors in determining the long-term preservation of renal function [22,23]. Furthermore, the selection of renorrhaphy technique is highly dependent on the surgeon's experience and approach to tumor removal [8]. Although the primary objective of renorrhaphy is to ensure hemostasis and reduce postoperative complications, the preservation of postoperative renal function remains controversial.…”

“…The following data were also collected as factors related to surgery: renorrhaphy method, console time, warm ischemic time (WIT), whether the collecting system was opened, estimated blood loss (EBL), blood transfusion, length of hospital stay (LOS), pathologic T classification, histological type, and resection margin status. To confirm the quality of surgery, we also evaluated whether the trifecta criteria (which comprised (1) negative surgical margins, (2) WIT within 25 min, and (3) the absence of perioperative complications) and the pentafecta criteria (which, in addition to the trifecta criteria, included (4) the maintenance of >90% postoperative renal function and (5) the absence of chronic kidney disease deterioration 1 year after surgery) were met [8,18]. The evaluation of renal function deterioration after RAPN was performed according to the method reported by Simon et al [19].…”

“…Similarly, renorrhaphy is a key process in achieving adequate hemostasis and renal reconstruction within an acceptable warm ischemic time during RAPN [6]. Four surgical techniques have been proposed for performing renorrhaphy: (1) single-layer lateral cortical renorrhaphy [8],…”

Outcomes and Techniques of Robotic-Assisted Partial Nephrectomy (RAPN) for Renal Hilar Masses: A Comprehensive Systematic Review

“…Renorrhaphy stands out as one of the key steps during RAPN, and this becomes technically more demanding in case of hilar masses due to its close proximity to critical structures [92][93][94][95]. Several strategies have been adopted and described to date [96][97][98][99][100][101].…”