Evolving renorrhaphy technique for retroperitoneal laparoscopic partial nephrectomy: single-surgeon series.
OBJECTIVE
To evaluate renorrhaphy techniques and to analyze surgical outcomes in retroperitoneal laparoscopic partial nephrectomy.


METHODS
A retrospective study from January 2008 to December 2011 analyzed 526 patients with renal tumors in whom renorrhaphy was changed from one layer, interrupted, figure-of-eight (n = 228) suture to two layers, continuous, unknotted (n = 298) suture. All procedures were carried out by the same laparoscopic surgeon (XZ). Patient demographics, tumor characteristics, operative outcomes and perioperative renal function were compared.


RESULTS
Median follow up for one layer, interrupted, figure-of-eight suture and two layers, continuous, unknotted suture was 31 and 28 months, respectively. The two layers, continuous, unknotted suture group had shorter warm ischemia time (P = 0.021), faster removal of Jackson-Pratt drains (P = 0.029) and shorter hospital stay (P = 0.037) than the one layer, interrupted, figure-of-eight suture group. There was a trend towards a better preservation of glomerular filtration rates in the two layers, continuous, unknotted suture group (P = 0.045). In a multivariable model, the two layers, continuous, unknotted suture technique was a statistically significant independent predictor of warm ischemia time (P = 0.01), hospital stay (P = 0.001) and estimated glomerular filtration rates (P = 0.043).


CONCLUSIONS
Two layers, continuous, unknotted suture renorrhaphy allows better outcomes than one layer, interrupted, figure-of-eight suture renorrhaphy in retroperitoneal laparoscopic partial nephrectomy. A longer clinical follow-up evaluation is warranted.
Department of Urology, Military Postgraduate Medical College, Chinese People's Liberation Army General Hospital, Beijing, China.
Wasilijiang
W
Wahafu
Xin
X
Ma
Hong-Zhao
HZ
Li
Qiang
Q
Ding
Bao-Jun
BJ
Wang
Tao-Ping
TP
Shi
Tao
T
Zheng
Jun
J
Dong
Wei
W
Cai
Xu
X
Zhang
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013536:Suture Techniques; D055815:Young Adult
outcomes; partial nephrectomy; renal tumors; renorrhaphy; retroperitoneal laparoscopy