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Simplified renorrhaphy using self-retaining barbed suture during laparoscopic partial nephrectomyRenorrafia simplificada empleando sutura barbada durante la nefrectomía parcial laparoscópica

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Abstract

Introduction and objectives

Laparoscopic partial nephrectomy (LPN) is a challenging procedure that requires quick and effective intracorporeal suturing that could limit widespread adoption. Refinements of surgery have improved warm ischemia times and facilitated renal reconstruction. We present a technique that makes renorrhaphy easier using self-retaining barbed suture (SRBS) weaving two threads.

Patients and methods

Two patients with carcinoma of the kidney, 3.4 and 1.5 cm, respectively, were subjected to the LPN. The SRBS is an absorbable polygluconate with small projections along its axis which are anchored in the tissue, distributing the tension of the suture line and eliminating the need for knots. Renorrhaphy was performed using the SRBS by two continuous suture lines without knots, setting the sutures with clips of Hem-o-lok® and adjusting it with the technique of “sliding clip”, without placing “bolsters” inside the renal parenchymal defect.

Results

Operative time was 156 min and 163 min, intraoperative bleeding was 50 ml and 850 ml, the warm ischemia time was 14.3 min and 23 min and follow-up time was 7 months and 3 months in the first and second cases, respectively. The hospital stay was 5 days and there were no postoperative complications.

Conclusions

Simplified renorrhaphy using SRBS is effective, hemostatic, facilitates the renal reconstruction, and can help reduce the warn ischemia time.

Resumen

Introducción y objetivos

La nefrectomía parcial laparoscópica (NPL) es una intervención desafiante que requiere sutura intracorpórea rápida y efectiva, lo que limita su aplicación de forma extendida. Refinamientos de la cirugía han mejorado los tiempos de isquemia y facilitado la reconstrucción renal. Se presenta una técnica que simplifica al máximo la renorrafia empleando sutura barbada de auto-retención (SBAR) entrelazando dos hilos.

Pacientes y métodos

A dos pacientes con carcinoma de riñón, de 3,4 y 1,5 cm respectivamente, se les realizó la NPL. La SBAR es un poligliconato absorbible con pequeños salientes a lo largo de su eje que se anclan en los tejidos, distribuyendo la tensión de la línea de sutura y eliminando la necesidad de nudos. La renorrafia se realizó con la SBAR mediante dos líneas de sutura continuas sin nudos, fijando los hilos con clips de Hem-o-lok® y ajustándolos con la técnica del «clip deslizante», sin colocación de bolsters dentro del defecto del parénquima renal.

Resultados

El tiempo operatorio fue de 156 y 163 minutos, el sangrado intraoperatorio fue de 50 y 850 ml, el tiempo de isquemia caliente fue de 14,3 y 23 minutos y el tiempo de seguimiento fue de 7 y 3 meses, en el primer y segundo caso respectivamente. La estancia hospitalaria fue de 5 días y no hubo complicaciones postoperatorias.

Conclusiones

La renorrafia simplificada empleando SBAR es efectiva, hemostática, facilita significativamente la reconstrucción renal y puede ayudar a disminuir los tiempos de isquemia.

Introduction

The development of laparoscopic and robotic surgery has allowed for the minimally invasive surgical procedures to obtain oncologic outcomes comparable to those of partial nephrectomy in renal masses smaller than 7 cm.1, 2 Laparoscopic partial nephrectomy (LPN) is a technically challenging procedure, which requires the acquisition of skills in advanced laparoscopic suture to perform renal reconstruction quickly under the pressure of the ischemia time. This makes this technique involve a long learning curve and a limited application to centers of excellence in laparoscopy.2, 3, 4, 5 Multiple refinements of the technique have been proposed to facilitate the preparation of the renorrhaphy during the LPN and decrease the ischemia times.1, 6, 7, 8 Together, new suture materials have been developed, such as the so-called self-retaining barbed suture (SRBS), which has allowed for reconstructive procedures in a more simple and safe way.7, 9, 10, 11 In order to facilitate renal reconstruction during LPN, we present a simplified renorrhaphy technique using the SRBS.

Section snippets

Patients and methods

Two patients with renal mass <4 cm were included, suitable for treatment by partial nephrectomy. The first case was a 47-year-old male patient with an incidental renal mass of 3.4 cm in the union of the upper and middle third of the left kidney. The second case was a 52-year-old female patient with a history of non-Hodgkin's lymphoma, with a neoproliferative injury of 1.5 cm in the upper pole of the left kidney.

Both patients underwent LNP with the simplified renorrhaphy technique using SRBS by

Results

The operative time was 156 and 163 min, the intraoperative bleeding was 50 ml and 850 ml, the warm ischemia time was 14.3 and 23 min, and the follow-up time was 7 and 3 months in the first and second case, respectively. In both patients, the hospital stay was 5 days and there were no postoperative complications. In the second case, there was inadvertent slippage of the Bulldog vascular clamp during the renorrhaphy, therefore, an intraoperative bleeding occurred, requiring blood transfusion.

Discussion

The LPN is a complex surgical technique with a long learning curve,2 and with significant complication rates, even in expert hands, intra-and postoperative bleeding, urinary fistulas, transfusion requirements, and positive surgical margins14 can often occur. That is why its application has been limited to centers with high experience in laparoscopy.1, 2, 14 However, contemporary innovations, in particular the advent of robotic surgery and the refinements of renorrhaphy, have simplified the

Conflict of interest

The authors declare that they have no conflict of interest.

References (15)

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Please cite this article as: García-Segui A, et al. Renorrafia simplificada empleando sutura barbada durante la nefrectomía parcial laparoscópica. Actas Urol Esp. 2012;36:497–502.

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