title: Knotless closure of the collecting system and renal parenchyma with a novel barbed suture during laparoscopic porcine partial nephrectomy.
abstract: BACKGROUND
  Closure of the urinary collecting system and renal parenchyma is a technically challenging aspect of laparoscopic nephron-sparing surgery and an obstacle to its more widespread use. A novel barbed polydioxanone suture material Quill self-retaining suture (SRS) (Angiotech Pharmaceuticals) has been introduced for knot-free tissue approximation. We compared the outcomes of Quill SRS versus a conventional technique for kidney and collecting system closure during laparoscopic porcine partial nephrectomy.
  
  
  METHODS
  After approval of the Institutional Animal Care and Use Committee, 10 female pigs underwent bilateral transperitoneal laparoscopic lower pole heminephrectomy. Closure of the collecting system and approximation of the renal parenchyma was performed in two layers using continuous knotless barbed suture for one kidney (Quill SRS) and polyglactin (Vicryl) with absorbable polydioxanone clips (LapraTy; Ethicon) on the contralateral kidney. For both techniques, the collecting system was closed with 2-0 suture and renal parenchyma with #1 suture. Warm ischemia and suturing time were recorded, and resected tissue was weighed. All animals were sacrificed 1 week after surgery. Serum hemoglobin and visual inspection at necropsy were used to assess for bleeding; visual inspection of the peritoneum and bilateral retrograde pyelography were used to assess for urinary fistula.
  
  
  RESULTS
  Mean (+/-standard deviation [SD]) weight of resected tissue (barbed, 34 +/- 13 g; clips, 34 +/- 11 g; p = 0.6), mean (+/-SD) ischemia time (barbed, 34 +/- 8 minutes; clips, 34 +/- 10 minutes; p = 0.7), and mean (+/-SD) suturing time (barbed, 21 +/- 4 minutes; clips, 22 +/- 7 minutes; p = 0.7) were similar between groups. No animal had a visible hematoma or urinoma at necropsy. On retrograde pyelography, a small urinary leak was found in two kidneys in each group (p = 0.6).
  
  
  CONCLUSIONS
  In a porcine laparoscopic partial nephrectomy model, it appears that knotless barbed suture is as effective, efficient, and safe as a conventional technique. Further evaluation in humans is warranted and required.
authors.affiliation: Department of Surgery, University of Chicago Medical Center, Chicago, IL 60637, USA.
authors.forename: Sergey
authors.initials: S
authors.lastname: Shikanov
authors.forename: Mark
authors.initials: M
authors.lastname: Wille
authors.forename: Michael
authors.initials: M
authors.lastname: Large
authors.forename: David A
authors.initials: DA
authors.lastname: Lifshitz
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Zorn
authors.forename: Arieh L
authors.initials: AL
authors.lastname: Shalhav
authors.forename: Scott E
authors.initials: SE
authors.lastname: Eggener
mesh_terms: D000818:Animals; D005260:Female; D007685:Kidney Tubules, Collecting / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000295:instrumentation*; D034421:Sus scrofa / Q000601:surgery*; D013537:Sutures; D014567:Urography