The Application Of Sutureless Laparoscopic Partial Nephrectomy With Monopoloar Coagulation And Its Protective Effect On Renal Function

Objective:With the popularization of physical examination,the detection rate of renal tumors,especially small renal tumors,is increasing.At present,it is considered that partial nephrectomy has better oncology and functional prognosis than radical nephrectomy for T1 stage renal tumor(<7cm).Minimally invasive surgery,represented by laparoscopic surgery,has gradually become the main choice of the current operation.Traditional laparoscopic partial nephrectomy requires three steps: renal pedicle block,tumor resection and renal parenchyma suture.Especially when the renal pedicle is blocked too long and the renal parenchyma is sutured too deep,the residual renal function may be damaged greatly and irreversible.Materials and methods:1.Retrospective analysis of the case data with the application of sutureless and clampless laproscopic partial nephrectomy with monopolar coagulation in Shengjing Hospital from February 2015 to October 2018.2.From February 2015 to October 2018,all cases of laparoscopic partial nephrectomy in Shengjing Hospital were analyzed retrospectively,and multiple renal tumors and renal dysfunction cases were excluded by screening T1 stage renal tumors.By means of propensity score matching(PSM),the effects of suturless laparoscopic partial nephrectomy and conventional laparoscopic partial nephrectomy on renal function were compared.3.The depth of renal parenchyma damage caused by monopolar coagulation was determined by a experiment in vitro,and compared with that caused by suture.The difference of HSP70 expression between the monopolar coagulation group and the suture group was confirmed by a rat experiment.Results:1.A total of 142 cases were included in the study,and the average age of all cases was 55 years old.There were 93 males and 49 females.The average size of the tumor was 3.2cm.The average RENAL score is 5.The average operation time was 120 minutes.The average estimated blood loss was 100 ml.Three of them received blood transfusion during or after operation.There were no cases of urinary leakage,no cases of open operation or nephrectomy during and after operation.A total of 98 cases received NBCA hemostatic glue for hemostasis,44 cases did not.The results of comparison between the two groups suggested that the patients in the NBCA group had larger tumor diameter and higher renal score,mainly higher E score.2.A total of 379 cases were included in the study.After PSM according to the preoperative case characteristics,a total of 116 pairs of cases were included in the study.Compared with the difference between the conventional group and the sutureless group,there was a significant difference between the two groups in the operation time and WIT.There was no significant difference in the estimation of blood loss,hospitalization time,blood transfusion cases,conversion to open surgery cases,,and local recurrence cases.There were significant differences in the changes of e GFR at one week or six months.After PSM within WIT,a total of 51 pairs of cases were included in the study.The difference of OT and WIT disappeared.There was no statistical difference in other perioperative indicators.However,there were still significant differences in the changes of e GFR at one week or six months.3.The damage depth of renal parenchyma by monopolar electrocoagulation was 2.5 mm,while that of suture group was 6 mm.The expression of HSP70 in the monopolar coagulation group was higher than that in the suture group.Conclusion: 1.Use of monopolar coagulation with NBCA in clampless and sutureless LPN for renal tumors with low RENAL nephrometry scores was safe and effective.For patients with exophytic renal tumors less than 2cm,NBCA is not necessary.2.Compared with traditional laparoscopic partial nephrectomy,sutureless laparoscopic partial nephrectomy has the same effect,and can effectively reduce the warm ischemia time,retain more renal parenchyma and protect renal function.3.The preservation of renal function by sutureless partial nephrectomy is achieved by reducing the damage of renal parenchyma and overexpression of HSP70.