A Modified Two-Layer Suture Technique for Transperitoneal Laparoscopic Partial Nephrectomy: Single-Center Clinical Experience.

Yang Jin,Hui Xiong,Qi Zhang,Qinghua Xia

doi:10.3389/fsurg.2021.761090

Abstract

PurposesThis study aims to evaluate the feasibility and efficacy of a modified two-layer suture method during laparoscopic partial nephrectomy (LPN) by a comparative analysis with the traditional two-layer suture.MethodsA total of 60 LPN patients were enrolled in this study, of which 30 patients received the modified two-layer suture method and the remaining 30 patients underwent the traditional two-layer suture. Then, surgical characteristics including operative time, warm ischemic time (WIT), estimated blood loss (EBL), and glomerular filtration rate (GFR) were recorded. Finally, univariable and multivariable linear regression analyses were used to evaluate the correlations of tumor characteristics, suture methods, and postoperative renal function.ResultsThere was no significant difference between the two suture groups with respect to patient and tumor characteristics, postoperative creatinine level, and blood urea nitrogen (BUN) level. The modified suture group showed a significantly shorter clamping time and a less GFR level reduction than the traditional two-layer suture group (15 vs. 23 min; 42.32 ± 9.48 vs. 27.07 ± 7.88; p < 0.05). Additionally, the modified two-layer suture was an independent factor that influenced the clamping time and the level of GFR reduction.ConclusionThe modified two-layer suture method is feasible and effective for LPN.

Highlights

Renal cell carcinoma (RCC) is a common malignant tumor in the genitourinary system with a higher incidence around the world [1]
Purposes: This study aims to evaluate the feasibility and efficacy of a modified two-layer suture method during laparoscopic partial nephrectomy (LPN) by a comparative analysis with the traditional two-layer suture
There was no significant difference between the two suture groups with respect to patient and tumor characteristics, postoperative creatinine level, and blood urea nitrogen (BUN) level

Summary

Introduction

Renal cell carcinoma (RCC) is a common malignant tumor in the genitourinary system with a higher incidence around the world [1]. Existing evidence has demonstrated that the practicability and reliability of LPN are based on multiple outcome measures, including margin negativity, reduced warm ischemic time (WIT), preserving the maximum amount of renal parenchyma, and decreased risks of postoperative bleeding, and urinary leakage [5, 6]. Multiple modified operation methods such as zero ischemia or off-clamp technique for LPN have been presented to reduce WIT duration, thereby minimizing the loss of renal function after LPN. These surgical procedures appear to be effective for small or peripheral RCC [8, 9]. The clinically contemporary techniques involve hilar clamping, which may cause an ischemic and long-term decline in kidney function [10]

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