Comparison Of Two Different Renorrhaphy Techniques In Retroperitoneal Laparoscopic Partial Nephrectomy For Complex Tumor

Objective To evaluate the efficacy of self-retaining suture (QuillTMSRS) in inretroperitoneal laparoscopic partial nephrectomy for complex tumor by assessingperioperative outcomes. Methods A retrospective analysis of78patients between2010and2012for complex renal mass (RENAL score≥7) in whom retroperitoneallaparoscopic partial nephrectomy(LPN) was performed with two layers usingcontinuous knotless barbed suture (QuillTMSRS group)(n=30)and traditionalabsorbable vicyl （non-SRS group）(n=48) respectively.In QuillTMSRS group,2-0QuillSRS was used to suture the deep tumor bed, and second outer layer renorrhaphy wasperformed with a1-0Quill SRS in the same fashion as the inner layer; In non-SRSgroup, the inner layer was sutured using a15cm long2-0monicryl suture with the samemethod of above. A second outer layer was closed with1-0vicryl suture across thedefect.Cases were matched for R.E.N.A.L score. Comparison were made in patients andpreoperative outcomes and perioperative complications between SRS group andnon-SRS group. Results Renorrhaphy was successfully performed in all the casesexcept1converting to open. Mean warm ischemia time in SRS group was shorter thannon-SRS group (18vs24.8min p=0.021);The proportion of bleeding requiringintervention in the non-SRS group （7/48,14.5%)was4.3-fold higher than for the SRSgroup (1/30,3.3%)，but the difference is not significant (P＞0.05）。There were nosignificant differences between two groups in the rate of postoperative changes increatinine.Limitations of this study include the absence of randomization and therelative small sample size. Conclusions SRS can be safely used for complex renaltumor during LPN,SRS can significantly reduce the WIT and may also reduce rates ofperioperative bleeding. Part two: The ulitity of barbed suture in laparoscopic partialnephrectomy for complex tumorObjective To evaluate the efficacy of self-retaining suture (SRS) in renorrhaphytechnique in retroperitoneal laparoscopic partial nephrectomy （LPN）for a single renalmass of moderate or high complexity by assessing peri-operative outcomes. MethodsA retrospective analysis of64patients between2010and2012for complex renal mass(RENAL score≥7) in whom retroperitoneal laparoscopic partial nephrectomy(LPN) wasperformed with two layers using continuous knotless barbed suture (Quill PDO SRSgroup)(n=34) and absorbable vicyl （non-SRS group）(n=30) respectively. Cases werematched for RENAL score. All the surgical procedures were performed by the samesurgeon with experience more than500cases of LPN. Comparisons were made inpatients and preoperative outcomes and peri-operative complications between SRSgroup and non-SRS group. Results Mean warm ischemia time（WIT）in SRS groupwas less than non-SRS group (18vs24.8min p=0.021). Renorrhaphy suture cost in SRSgroup was lower than non-SRS group(﹩269.6versus﹩335.8, p=0.001). There wereno significant difference between two groups for postoperative changes in creatinineand eGFR and the rate of peri-operative complications. Conclusions SRS was safety forcomplex renal tumor with two layers continous and unknot suture during LPN, andwould reduce the WIT and renorrhaphy suture cost significantly.