title: Ring Suture Technique in Retroperitoneal Laparoscopic Partial Nephrectomy for Hilar Cancer: A New Renorrhaphy Technique.
abstract: OBJECTIVE
  To evaluate the safety and efficacy of a ring suture technique during retroperitoneal laparoscopic partial nephrectomy (RLPN) for management of renal cell carcinoma (RCC) in the renal hilum.
  
  
  METHODS
  Data for patients with renal hilar cancer who underwent RLPN from January 2010 to March 2015 were collected. All surgeries involved the ring suture technique, following the same procedure: the renal artery was dissected and clamped, the tumor was enucleated from the kidney, defects of the vascular and collecting system were repaired, and then the edge of the renal parenchyma was sutured continuously along the border. Finally, the renal artery clamp was removed, and any injury of the vascular system was repaired if necessary. We retrospectively analyzed renal ischemic time, blood loss, and postoperative complications.
  
  
  RESULTS
  Among the 17 patients, 11 were male (median age 61 years, range 42-71 years). Mean tumor diameter was 3.4 ± 0.9 cm and median R.E.N.A.L. nephrometry score was 8 (range 6-10). The mean warm ischemic time was 23.0 ± 9.2 minutes and median blood loss during surgery was 110 mL (range 70-350 mL); we had no case of uncontrollable massive bleeding. Radical nephrectomy was used in one case because of tumor embolus in a branch of the renal vein. All patients recovered well following surgery. Pathology confirmed the diagnosis of RCC in all cases, with the main subtype clear-cell carcinomas (88.2%).
  
  
  CONCLUSIONS
  The ring suture technique is safe and effective for management of renal hilar cancer during RLPN for selected patients.
authors.affiliation: 1 Department of Urology, Peking University First Hospital , Beijing, China .|2 Institute of Urology, Peking University , Beijing, China .|3 National Urological Cancer Center , Beijing, China .
authors.forename: Cuijian
authors.initials: C
authors.lastname: Zhang
authors.affiliation: 1 Department of Urology, Peking University First Hospital , Beijing, China .|2 Institute of Urology, Peking University , Beijing, China .|3 National Urological Cancer Center , Beijing, China .
authors.forename: Xuesong
authors.initials: X
authors.lastname: Li
authors.affiliation: 1 Department of Urology, Peking University First Hospital , Beijing, China .|2 Institute of Urology, Peking University , Beijing, China .|3 National Urological Cancer Center , Beijing, China .
authors.forename: Wei
authors.initials: W
authors.lastname: Yu
authors.affiliation: 1 Department of Urology, Peking University First Hospital , Beijing, China .|2 Institute of Urology, Peking University , Beijing, China .|3 National Urological Cancer Center , Beijing, China .
authors.forename: Qian
authors.initials: Q
authors.lastname: Zhang
authors.affiliation: 1 Department of Urology, Peking University First Hospital , Beijing, China .|2 Institute of Urology, Peking University , Beijing, China .|3 National Urological Cancer Center , Beijing, China .
authors.forename: Liqun
authors.initials: L
authors.lastname: Zhou
authors.affiliation: 1 Department of Urology, Peking University First Hospital , Beijing, China .|2 Institute of Urology, Peking University , Beijing, China .|3 National Urological Cancer Center , Beijing, China .
authors.forename: Zhisong
authors.initials: Z
authors.lastname: He
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical; D002292:Carcinoma, Renal Cell / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology; D012077:Renal Artery / Q000601:surgery; D012187:Retroperitoneal Space; D012189:Retrospective Studies; D013536:Suture Techniques; D047368:Tumor Burden; D052096:Warm Ischemia