Skill and talentSimplified renorrhaphy using self-retaining barbed suture during laparoscopic partial nephrectomyRenorrafia simplificada empleando sutura barbada durante la nefrectomía parcial laparoscópica☆
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.
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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.