Z-shaped running suture for outer layer renorrhaphy during robot-assisted partial nephrectomy

Minerva Urology and Nephrology, vol. 75, pp. 217–222

Abstract

BACKGROUND: The aim of this study was to describe a novel outer layer renorrhaphy strategy during robot-assisted partial nephrectomy. METHODS: This technique is presented in key steps. Renorrhaphy is performed with a double layer technique. The novel strategy of outer layer renorrhaphy is to approach the parenchymal margins in a zigzag-shaped manner with a 2-0 Vicryl running suture. Each pass begins immediately adjacent to the exit site. The needle is passed through the defect and the exiting suture is secured with a Hem-o-lok clip. At each exit site, the suture is secured with a Hem-o-lok clip. A second Hem-o-lok clip is placed at the loose ends, to tighten the suture in the clip locking mechanism. Patients submitted to robot-assisted partial nephrectomy at a single institution between January 2017 and January 2022 were included in the analysis. Descriptive statistics of baseline characteristics and surgical, pathological, and oncological outcomes were analyzed. RESULTS: One hundred fifty-nine consecutive patients were recorded; 103 (64.8%) of them presented with a cT1a renal mass. Median (interquartile range [IQR]) total operative time was 146 (120-182) minutes. There was no conversion to open surgery, while 5 (3.1%) patients were converted to radical nephrectomy. We reported an overall low rate of postoperative complications. There were 5 documented perirenal hematomas and 6 cases of urinary leakage (2 pT2a, 2 pT1b, 2 pT1a renal cell carcinoma). CONCLUSIONS: Z-shaped technique is a feasible and safe alternative for renorrhaphy of the outer layer, in experienced hands. Future comparative studies are needed to confirm our results.

Authors 11

1. Francesca Ambrosini corresponding

   Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda · Ospedale Policlinico San Martino

   Affiliation as printed

   Department of Urology, ASST Niguarda Hospital, Milan, Italy - f. ambrosini1@gmail.com

   Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy - f. ambrosini1@gmail.com

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

   Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

2. Paolo Dell’Oglio Aachen Department of Radiology Laboratory of Interventional Molecular Imaging

   Leiden University Medical Center · Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

   Affiliation as printed

   Department of Radiology, Laboratory of Interventional Molecular Imaging, Leiden University Medical Center, Leiden, the Netherlands

   Department of Urology, ASST Niguarda Hospital, Milan, Italy;

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

3. Erika Palagonia

   Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

   Affiliation as printed

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

4. Carlo Buratto

   Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

   Affiliation as printed

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

5. Marco Martiriggiano

   Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda · Ospedale Policlinico San Martino

   Affiliation as printed

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

   Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

6. Michele Barbieri

   Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

   Affiliation as printed

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

7. Silvia Secco

   Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

   Affiliation as printed

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

8. Alberto Olivero

   Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

   Affiliation as printed

   Department of Urology, ASST Niguarda Hospital, Milan, Italy

9. Carlo Terrone

   Ospedale Policlinico San Martino

   Affiliation as printed

   Department of Urology, IRCCS Ospedale Policlinico San Martino, Genoa, Italy

10. Aldo Massimo Bocciardi

    Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

    Affiliation as printed

    Department of Urology, ASST Niguarda Hospital, Milan, Italy

11. Antonio Galfano

    Azienda Socio Sanitaria Territoriale Grande Ospedale Metropolitano Niguarda

    Affiliation as printed

    Department of Urology, ASST Niguarda Hospital, Milan, Italy