Do nonspecific deep corticomedullary sutures performed during partial nephrectomy adequately control major vascular and collecting system injury?
OBJECTIVE
To critically evaluate the effectiveness of placing nonspecific deep corticomedullary sutures in the setting of major vascular and collecting system injury during laparoscopic partial nephrectomy (LPN). We also aimed to evaluate the incidence of ischaemic injury to the remaining renal remnant because of these sutures, as many laparoscopic centres have adopted this practice.


METHODS
We performed open PN on eight porcine kidneys. Both the artery and vein were clamped. The ureter was transected and tied around an angiocatheter for evaluating collecting system integrity both before and after corticomedullary suturing. The renal artery was cannulated for angiography before and after the corticomedullary suturing. The rate of bleeding was also assessed before and after corticomedullary suturing.


RESULTS
There was marked arterial bleeding and large collecting system injury induced in all kidneys. Two of the eight renal units continued to have significant arterial bleeding after the deep corticomedullary sutures were placed. All of the eight units had at least a small urinary leak after suturing, with three having medium-to-large leaks. In four of the renal units, there were major segmental vessels occluded by the sutures, as detected by angiography.


CONCLUSIONS
The practice of placing nonspecific deep corticomedullary sutures, during PN, may not adequately control major vascular and collecting system injury. In addition, segmental vessels supplying remnant renal tissue are often affected; thereby further compromising function because of devascularization. The search for the best technique for LPN continues.
L'esperance
James O
JO
Department of Urology, Naval Medical Center San Diego, San Diego, CA, USA. james.lesperance@med.navy.mil
Marguet
Charles G
CG
Walters
R Chanc
RC
Sung
Jeffrey C
JC
Auge
Brian K
BK
Stroup
Sean P
SP
L'esperance
Audry H
AH
Albala
David M
DM
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D006488:Hemostasis, Surgical; D007431:Intraoperative Complications / Q000517:prevention & control*; D007668:Kidney / Q000098:blood supply / Q000601:surgery; D007685:Kidney Tubules, Collecting / Q000293:injuries*; D010535:Laparoscopy / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D012077:Renal Artery / Q000293:injuries*; D013536:Suture Techniques; D013537:Sutures; D013552:Swine