title: V-hilar suture renorrhaphy during robotic partial nephrectomy for renal hilar tumors: preliminary outcomes of a novel surgical technique.
abstract: OBJECTIVE
  To report the preliminary outcomes of a novel renorrhaphy surgical technique, V-hilar suture (VHS), developed and implemented at our institution to manage hilar masses chosen for robotic partial nephrectomy.
  
  
  METHODS
  Of all patients who underwent robotic partial nephrectomy for a single renal tumor from June 2007 to October 2011, 15 had hilar renal tumors. Of these 15 patients, only 5 had been considered for VHS renorrhaphy and were compared with the rest. The patients' demographic and perioperative data were recorded. They were followed up postoperatively for renal function. The VHS renorrhaphy was obtained by first having inner layer sutures to reshape the renal parenchyma with medialization of the central-lateral border of the resection bed. Next, a continuous horizontal mattress suture was used to reapproximate the renal capsule.
  
  
  RESULTS
  The main patient and tumor characteristics were comparable between the 2 groups. No difference was found in terms of operating room time or warm ischemia time. A trend was noted in favor of the VHS group for estimated blood loss (250 vs 575 mL; P = .137), postoperative complications (2 vs 6; P = .056), and hospital stay (2.6 vs 6.6 days; P = .157). No significant difference was found in the postoperative changes in the estimated glomerular filtration rate between the 2 groups.
  
  
  CONCLUSIONS
  The preliminary outcomes of the present surgical technique have demonstrated its safety and efficacy. It might represent a valuable asset for robotic surgeons treating complex hilar renal tumors. Additional larger studies with longer follow-up are required to confirm these encouraging findings.
authors: Center for Laparoscopic and Robotic Surgery, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
authors: Ali
authors: A
authors: Khalifeh
authors: Riccardo
authors: R
authors: Autorino
authors: Shahab P
authors: SP
authors: Hillyer
authors: Jihad H
authors: JH
authors: Kaouk
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012189:Retrospective Studies; D012371:Robotics; D013536:Suture Techniques; D016896:Treatment Outcome