title: Barbed suture for renorrhaphy during robot-assisted partial nephrectomy.
abstract: OBJECTIVE
  Robot-assisted partial nephrectomy (RAPN) is an emerging technique for minimally invasive nephron-sparing surgery that may facilitate the technical challenges of sutured renorrhaphy. Barbed suture allows for knotless wound closure and improves suturing efficiency. We present the first clinical study of barbed suture for renorrhaphy during RAPN in human patients and compare perioperative outcomes to RAPN with polyglactin suture.
  
  
  METHODS
  Thirty consecutive patients underwent RAPN by a single surgeon; 15 using polyglactin suture for renorrhaphy followed by 15 using the V-Loc 180 wound closure device. Renorrhaphy was performed in two layers, with a continuous running closure of deep vessels and the collecting system, followed by a running closure of the renal capsule, using the sliding Hem-o-lok clip technique. Operative characteristics and complications were compared between groups.
  
  
  RESULTS
  Renorrhaphy was successfully completed in all 30 consecutive RAPN procedures. V-Loc and conventional groups were equivalent in demographic and tumor characteristics. Mean operative and console time were equivalent; warm ischemia time was significantly shorter in the V-Loc group (18.5 vs 24.7 min, P = 0.008). There were no instances of suture slippage or tearing in the barbed suture group. The barbs held the sliding clip renorrhaphy intact without the need for redundant clips to prevent backsliding.
  
  
  CONCLUSIONS
  Use of barbed suture simplifies the renorrhaphy technique during RAPN and improves efficiency, allowing for reduced warm ischemia times. We demonstrate feasibility and safety of this suture technique in human patients undergoing minimally invasive partial nephrectomy.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan 48202, USA. jsammon1@hfhs.org
authors.forename: Jesse
authors.initials: J
authors.lastname: Sammon
authors.forename: Firas
authors.initials: F
authors.lastname: Petros
authors.forename: Shyam
authors.initials: S
authors.lastname: Sukumar
authors.forename: Akshay
authors.initials: A
authors.lastname: Bhandari
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kaul
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.forename: Craig
authors.initials: C
authors.lastname: Rogers
mesh_terms: D006801:Humans; D007668:Kidney / Q000601:surgery*; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics / Q000379:methods*; D013536:Suture Techniques; D013537:Sutures; D016896:Treatment Outcome