Introducing enhanced parenchyma suturing during robot-assisted, laparoscopic and open partial nephrectomy for achieving better perioperative results

Abstract

AIM OF STUDY. To improve the main perioperative results of robotic (RPN), laparoscopic (LPN) and open (OPN) partial nephrectomy by employment of new parenchyma suture using contemporary suture material. PATIENTS AND METHODS. In this study 168 patients with T1N0M0 stage renal cell carcinoma were treated via OPN, LPN and RPN (97, 41 and 30 patients, respectively). Every group was divided in two: in the first one (basic subgroup) kidney’s parenchyma was sutured with Vicryl and Lapra-Ty clips (only Vicryl for the OPN group) and in the second one parenchyma was sutured with modified technique (modified subgroup) using V-loc, Hem-o-Lok and modified Z-shaped stitches in LPN and RPN groups (no V-loc for OPN group). We compared mean operation time, WIT, blood loss and alteration of serum creatinine and glomerular filtrarion rate (GFR) between subgroups in every group. RESULTS. In the modified subgroup of OPN group WIT was shorter compared to the basic subgroup (11,1 vs 14,6 min; p=0,044). In LPN group mean operation time was shorter in modified subgroup (135,4 vs 185,0 min; p=0,011) as well as WIT (14,1 vs 19,3 min; p=0,0003). Blood loss was also less in modified subgroup (286,1 vs 347,0 ml; p=0,033). In the modified subgroup of RPN group WIT was less than in basic subgroup (12,0 vs 15,7 min; p=0,001); the elevation of serum creatinine level was less (6,0% vs 24,8 %; p=0,019) and depression of GFR was lower (4,0% vs 22,2%; p=0,041). CONCLUSION. The application of V-loс and Hem-o-Lok and Z-shaped suturing technique during suturing in partial nephrectomy reduces WIT and mean operation time and decreases blood loss.