title: Feasibility of omitting cortical renorrhaphy during robot-assisted partial nephrectomy: a matched analysis.
abstract: OBJECTIVE
  To assess the safety of omitting cortical renorrhaphy during robot-assisted partial nephrectomy and measure preliminary functional outcomes.
  
  
  METHODS
  Fifteen robot-assisted partial nephrectomies were performed with a running, base-layer suture for the collecting system and vessel hemostasis but without cortical renorrhaphy. The nonrenorrhaphy group was matched 1:2 by R.E.N.A.L. nephrometry score to a running, sliding-clip cortical renorrhaphy group retrospectively. Intraoperative blood loss, urine leaks, postoperative bleeds, and functional outcomes were evaluated. Predictors of %volume loss were evaluated using multivariable regression.
  
  
  RESULTS
  No differences were seen between renorrhaphy and nonrenorrhaphy in sex (P=0.53), age (P=0.14), body mass index (P=0.08), Charlson score (P=0.44), tumor diameter (P=0.55), nephrometry score (P=0.77), preoperative glomerular filtration rate (GFR, P=0.63), or the amount of resected healthy kidney margin (P=0.21). Warm ischemia time was less for the nonrenorrhaphy group (P<0.002). One pseudoaneurysm necessitating embolization (1/30=3%) was seen in the renorrhaphy group compared with none in the nonrenorrhaphy group. No urine leaks occurred in either group. The median %GFR loss was 8.8% for renorrhaphy and 4.4% for nonrenorrhaphy (P=0.14) at a median follow-up of 4.1 months. The median %volume loss was 17 cm(3) for renorrhaphy and 9 cm(3) for nonrenorrhaphy (P=0.003). In a multivariable model, both cortical renorrhaphy (P=0.004) and tumor diameter (P=0.004) were predictors of %volume loss.
  
  
  CONCLUSIONS
  Omission of cortical renorrhaphy appears feasible with no urine leaks or bleeding complications observed. The percent renal volume loss was improved by omission of cortical renorrhaphy. Reconstruction technique is important to control for when studying renal function after partial nephrectomy.
authors.affiliation: 1 Department of Urology, Indiana University , Indianapolis, Indiana.
authors.forename: Clinton D
authors.initials: CD
authors.lastname: Bahler
authors.forename: Hitesh T
authors.initials: HT
authors.lastname: Dube
authors.forename: Kevin J
authors.initials: KJ
authors.lastname: Flynn
authors.forename: Swapnil
authors.initials: S
authors.lastname: Garg
authors.forename: M Francesca
authors.initials: MF
authors.lastname: Monn
authors.forename: Luke G
authors.initials: LG
authors.lastname: Gutwein
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Mellon
authors.forename: Richard S
authors.initials: RS
authors.lastname: Foster
authors.forename: Liang
authors.initials: L
authors.lastname: Cheng
authors.forename: M Kumar
authors.initials: MK
authors.lastname: Sandrasegaran
authors.forename: Chandru P
authors.initials: CP
authors.lastname: Sundaram
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D015992:Body Mass Index; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D009929:Organ Size; D019106:Postoperative Hemorrhage / Q000453:epidemiology*; D019651:Plastic Surgery Procedures; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000379:methods*; D013536:Suture Techniques; D013537:Sutures; D052096:Warm Ischemia; D055815:Young Adult