title: Functional Duration of Closure Systems Used in Partial Nephrectomy.
abstract: We determined the functional life of various configurations of partial nephrectomy closure systems.
  
  
  
  Sutures were prepared using standard techniques for sutured renorrhaphy during partial nephrectomy. Tested systems included knot/Hem-o-Lok®, Lapra-Ty®/Hem-o-Lok and Hem-o-Lok/Hem-o-Lok combinations. The saline filled tank was maintained at 37C. Vicryl®, Stratafix™ polyglycolic acid-polycaprolactone or V-Loc™ 180 sutures were suspended at 4 or 2 N. Suture material breakage or slippage was considered failure.
  
  
  
  At 4 N 20% of sutures terminated with knot/Hem-o-Lok failed by 3 weeks compared to 56% and 100% terminated with Lapra-Ty/Hem-o-Lok and Hem-o-Lok/Hem-o-Lok, respectively (p <0.0001). The 55% and 100% of failures with Lapra-Ty/Hem-o-Lok and Hem-o-Lok/Hem-o-Lok, respectively, were generally due to slippage vs 11% with knot/Hem-o-Lok (p <0.0001). Overall failure rates with Lapra-Ty/Hem-o-Lok for zero to 4-zero sutures were 41% with Vicryl, 82% with polyglycolic acid-polycaprolactone and 24% with V-Loc 180 (p <0.0001). The only sutures without failure at 4 N with Lapra-Ty/Hem-o-Lok and knot/Hem-o-Lok closure systems were Vicryl zero, and V-Loc 2-zero and 3-zero. At 2 N Lapra-Ty/Hem-o-Lok failure (17.5% vs 0%, p = 0.039) and Hem-o-Lok/Hem-o-Lok failure (39% vs 16%, p = 0.074) were more common with polyglycolic acid-polycaprolactone than with V-Loc sutures.
  
  
  
  Hem-o-Lok/Hem-o-Lok and Lapra-Ty/Hem-o-Lok combinations resulted in more frequent failures at 3 weeks or greater than knot/Hem-o-Lok. For all sutures tested knots were superior to Lapra-Tys to backstop Hem-o-Loks at 4 N. Preferably, Vicryl zero or V-Loc 2-zero/3-zero sutures should be used in combination with knots or Lapra-Tys at 4 N. Under these experimental conditions the Lapra-Ty/Hem-o-Lok combination did not reliably suspend the other sutures tested for 3 weeks. If Lapra-Ty/Hem-o-Lok or Hem-o-Lok/Hem-o-Lok combinations are used, we recommend closure at lesser tension and/or the use of appropriate sutures.
authors.affiliation: Forest Hills Central High School, Grand Rapids, Michigan.
authors.forename: Ruchir
authors.initials: R
authors.lastname: Gupta
authors.affiliation: Grand Valley State University, Grand Rapids, Michigan.
authors.forename: Nadia
authors.initials: N
authors.lastname: Sunny
authors.affiliation: Division of Urology, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Sabrina L
authors.initials: SL
authors.lastname: Noyes
authors.affiliation: Division of Urology, Spectrum Health, Grand Rapids, Michigan.
authors.forename: Mouafak
authors.initials: M
authors.lastname: Tourojman
authors.affiliation: Grand Valley State University, Grand Rapids, Michigan.
authors.forename: Bikal
authors.initials: B
authors.lastname: Paka
authors.affiliation: Grand Valley State University, Grand Rapids, Michigan.
authors.forename: Robert
authors.initials: R
authors.lastname: Bossemeyer
authors.affiliation: Division of Urology, Spectrum Health, Grand Rapids, Michigan; College of Human Medicine, Michigan State University, Grand Rapids, Michigan. Electronic address: brian.lane@spectrumhealth.org.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Lane
mesh_terms: D004868:Equipment Failure; D008422:Materials Testing; D009392:Nephrectomy / Q000379:methods*; D013536:Suture Techniques; D013537:Sutures; D013997:Time Factors
keywords: equipment failure analysis; kidney; nephrectomy; postoperative complications; sutures