Renorrhaphy techniques and effects on renal function with robotic partial nephrectomy

Abstract

The management of small renal masses has evolved over the past several years. Partial nephrectomy is now thought of as the standard of care for the management of small renal masses. Bleeding and calyceal injuries can be challenging to manage and make the procedure technically challenging. The debate between renorrhaphy techniques during robot-assisted partial nephrectomy represents a subject of ongoing discourse. We aim to compare the perioperative and functional outcomes of different renorrhaphy during robot-assisted partial nephrectomy. Our study suggests that different renorrhaphy techniques demonstrated comparable perioperative and functional outcomes in terms of renal function.

Keywords

Robotic-assisted partial nephrectomy / renorraphy / renal function

References

[1] Silagy AW,Kelly BD.Surgical innovation revisited: a historical narrative of the minimally invasive “Agarwal sliding-clip renorrhaphy” technique for partial nephrectomy and its application to an Australian cohort.BJUI Compass2021;2:211-8 PMCID:PMC8988750

[2] Herr HW.A history of partial nephrectomy for renal tumors.J Urol2005;173:705-8

[3] Luciani LG,Tallarigo C.Incidental renal cell carcinoma-age and stage characterization and clinical implications: study of 1092 patients (1982-1997).Urology2000;56:58-62

[4] Van Poppel H,Albrecht W.A prospective, randomised EORTC intergroup phase 3 study comparing the oncologic outcome of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.Eur Urol2011;59:543-52

[5] Scosyrev E,Sylvester R,Van Poppel H.Renal function after nephron-sparing surgery versus radical nephrectomy: results from EORTC randomized trial 30904.Eur Urol2014;65:372-7

[6] Van Poppel H, Da Pozzo L, Albrecht W, et al; European Organization for Research and Treatment of Cancer (EORTC), National Cancer Institute of Canada Clinical Trials Group (NCIC CTG), Southwest Oncology Group (SWOG), Eastern Cooperative Oncology Group (ECOG). A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma.Eur Urol2007;51:1606-15

[7] Campbell S,Allaf ME.Renal mass and localized renal cancer: AUA guideline.J Urol2017;198:520-9

[8] Ljungberg B,Abu-Ghanem Y.European association of urology guidelines on renal cell carcinoma: the 2019 update.Eur Urol2019;75:799-810

[9] Buffi NM, Saita A, Lughezzani G, et al; ERUS Scientific Working Group. Robot-assisted partial nephrectomy for complex (PADUA score ≥10) tumors: techniques and results from a multicenter experience at four high-volume centers.Eur Urol2020;77:95-100

[10] Hung AJ,Simmons MN.“Trifecta” in partial nephrectomy.J Urol2013;189:36-42

[11] Antonelli A,Francavilla S.On-clamp versus off-clamp robotic partial nephrectomy: a systematic review and meta-analysis.Urologia2019;86:52-62

[12] Minervini A,Sessa F.Positive surgical margins and local recurrence after simple enucleation and standard partial nephrectomy for malignant renal tumors: systematic review of the literature and meta-analysis of prevalence.Minerva Urol Nefrol2017;69:523-38

[13] Veccia A,Hampton LJ.Near-infrared fluorescence imaging with indocyanine green in robot-assisted partial nephrectomy: pooled analysis of comparative studies.Eur Urol Focus2020;6:505-12

[14] Bahler CD.Effect of renal reconstruction on renal function after partial nephrectomy.J Endourol2016;30:S37-41

[15] Lane BR,Uzzo RG.Comparison of cold and warm ischemia during partial nephrectomy in 660 solitary kidneys reveals predominant role of nonmodifiable factors in determining ultimate renal function.J Urol2011;185:421-7

[16] Mir MC,Sharma N.Parenchymal volume preservation and ischemia during partial nephrectomy: functional and volumetric analysis.Urology2013;82:263-8

[17] Gettman MT,Chow GK,Bartsch G.Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system.Urology2004;64:914-8

[18] Jeon HG,Hwang JH,Lee SR.Prognostic significance of preoperative kidney volume for predicting renal function in renal cell carcinoma patients receiving a radical or partial nephrectomy.BJU Int2012;109:1468-73

[19] Sharma N,Novick AC,Remer EM.Correlation between loss of renal function and loss of renal volume after partial nephrectomy for tumor in a solitary kidney.J Urol2008;179:1284-8

[20] Simmons MN,Campbell SC.Effect of parenchymal volume preservation on kidney function after partial nephrectomy.J Urol2011;186:405-10

[21] Bertolo R, Campi R, Klatte T, et al; Young Academic Urologists (YAU) Kidney Cancer working group of the European Urological Association (EAU). Suture techniques during laparoscopic and robot-assisted partial nephrectomy: a systematic review and quantitative synthesis of peri-operative outcomes.BJU Int2019;123:923-46

[22] Shatagopam K,Sundaram CP.Renorrhaphy techniques and effect on renal function with robotic partial nephrectomy.World J Urol2020;38:1109-12

[23] Ramanathan R.A review of methods for hemostasis and renorrhaphy after laparoscopic and robot-assisted laparoscopic partial nephrectomy.Curr Urol Rep2010;11:208-20

[24] Desai MM.Laparoscopic partial nephrectomy for tumour: current status at the Cleveland Clinic.BJU Int2005;95:41-5

[25] Benway BM,Cabello JM.Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes.Eur Urol2009;55:592-9

[26] Orvieto MA,Laven B,Sokoloff MH.Eliminating knot tying during warm ischemia time for laparoscopic partial nephrectomy.J Urol2004;172:2292-5

[27] Orvieto MA,Tolhurst SR.Simplifying laparoscopic partial nephrectomy: technical considerations for reproducible outcomes.Urology2005;66:976-80

[28] Benway BM,Figenshau RS.Sliding-clip renorrhaphy provides superior closing tension during robot-assisted partial nephrectomy.J Endourol2010;24:605-8

[29] Sammon J,Sukumar S.Barbed suture for renorrhaphy during robot-assisted partial nephrectomy.J Endourol2011;25:529-33

[30] Farinha R,Paludo AO.Selective suturing or sutureless technique in robot-assisted partial nephrectomy: results from a propensity-score matched analysis.Eur Urol Focus2022;8:506-13

[31] Brassetti A,Anceschi U.Sutureless purely off-clamp robot-assisted partial nephrectomy: avoiding renorrhaphy does not jeopardize surgical and functional outcomes.Cancers2023;15:698 PMCID:PMC9913582

[32] Vyas KS.Comparison of hemostatic agents used in vascular surgery.Expert Opin Biol Ther2013;13:1663-72 PMCID:PMC4390172

[33] Franco A,Tema G.Renal function preservation in purely off-clamp sutureless robotic partial nephrectomy: initial experience and technique.Diagnostics2024;14:1579 PMCID:PMC11311424

[34] De Nunzio C,Brassetti A.Purely off-clamp sutureless robotic partial nephrectomy for novice robotic surgeons: a multi-institutional propensity score-matched analysis.J Clin Med2024;13:3553 PMCID:PMC11204664

[35] Bertolo R, Campi R, Mir MC, et al; Young Academic Urologists Kidney Cancer Working Group of the European Urological Association. Systematic review and pooled analysis of the impact of renorrhaphy techniques on renal functional outcome after partial nephrectomy.Eur Urol Oncol2019;2:572-5

[36] Bahler CD,Garg S.Differentiating reconstructive techniques in partial nephrectomy: a propensity score analysis.Can J Urol2015;22:7788-96

[37] Porpiglia F,Amparore D.PE18 - Single-layer versus double-layer renorrhaphy during minimally-invasive partial nephrectomy: are there effects on renal function?.Eur Urol Suppl2016;15:236

[38] Bahler CD,Flynn KJ.Feasibility of omitting cortical renorrhaphy during robot-assisted partial nephrectomy: a matched analysis.J Endourol2015;29:548-55

[39] Desai MM,Kaouk JH,Novick AC.Laparoscopic partial nephrectomy with suture repair of the pelvicaliceal system.Urology2003;61:99-104

[40] Kaygisiz O,Vuruşkan BA.Comparison of two different suture techniques in laparoscopic partial nephrectomy.Int Braz J Urol2017;43:863-70 PMCID:PMC5678517

[41] Kim KS,Kim JH.Running-clip renorrhaphy reducing warm ischemic time during laparoscopic partial nephrectomy.J Laparoendosc Adv Surg Tech A2015;25:50-4

[42] Canales BK,Fernandes E,Ramani AP.Novel technique of knotless hemostatic renal parenchymal suture repair during laparoscopic partial nephrectomy.Urology2007;70:358-9

[43] Baumert H,Shah N.Reducing warm ischaemia time during laparoscopic partial nephrectomy: a prospective comparison of two renal closure techniques.Eur Urol2007;52:1164-9

[44] Williams RD,Frank R.Has sliding-clip renorrhaphy eliminated the need for collecting system repair during robot-assisted partial nephrectomy?.J Endourol2017;31:289-94

[45] Bertolo R, Pecoraro A, Carbonara U, et al; European Association of Urology Young Academic Urologists Renal Cancer Working Group. Resection techniques during robotic partial nephrectomy: a systematic review.Eur Urol Open Sci2023;52:7-21 PMCID:PMC10172691