Can a single-layer of renorrhaphy be applied with hemostatic agent in robot-assisted laparoscopic nephron-sparing surgery applied to complex renal tumors?

Year 2023, Volume: 18 Issue: 1, 55 - 61, 27.02.2023

Tahsin Batuhan Aydoğan , Murat Bınbay

https://doi.org/10.33719/yud.2023;18-1-1191867

Abstract

Objective: To compare outcomes of single-layer renorrhaphy suturing and hemostatic agent application with double-layer renorrhaphy among complex renal tumors.
Material and Methods: 51 patients who underwent robotic partial nephrectomy due to complex renal tumors (PADUA score ≥10) between August 2017 and February 2021 were retrospectively enrolled. A double-layer renorrhaphy was applied in 36 patients (Group 1), and a single-layer renorrhaphy plus hemostatic agent FloSeal® (Baxter Medical, Fremont, CA) was applied in 15 patients (Group 2). Pre- and post-operative serum creatinine, glomerular filtration rate, hemoglobin levels, surgical and warm ischemia time, drainage, hospital stay duration, as well as complications were all evaluated.
Results: Group 1 and Group 2 mean PADUA scores were 11 and 10.47, respectively. The mean preoperative, postoperative 1st day and 6th month serum creatinine ​​were 1.02, 1.15 and 1.09 mg/dL in the Group 1 and were 0.93, 1.02 and 0.90 mg/dL in the Group 2, respectively. The mean preoperative, postoperative 1st day and 6th month glomerular filtration rates ​​were 91.47, 77.31 and 81.90 mL/min/1.73m2 in the Group 1 and were 92.07, 84.93 ve 90.73 mL/min/1.73m2 in the Group 2, respectively. Operation and warm ischemia time were 118min and 23min in the Group 1, and 101min and 13 min in the Group 2, respectively. There was no significant difference between groups in terms of drain removal time and hospital stay. Perioperative only Clavien I and II complications were observed with no recurrence during the follow-up.
Conclusion: A single-layer of renorrhaphy plus hemostatic agent application can be safely applied in complex renal tumors with a PADUA score between 10-11 undergoing robotic partial nephrectomy.

Keywords

Robotic partial nephrectomy , Nephron sparing surgery , Renorrghaphy , Complex renal tumor

Kompleks renal tümörlerde uygulanan robot yardımlı laparoskopik nefron koruyucu cerrahide hemostatik ajan eşliğinde tek kat renorrafi uygulanabilir mi?

Abstract

Amaç: Kompleks renal tümör nedenli robotik parsiyel nefrektomi uygulanan hastalarda hemostatik ajan eşliğinde tek kat renorrafi ile çift kat renorrafi kullanımı sonuçlarının karşılaştırılması amaçlanmıştır.
Gereç ve Yöntemler: Ağustos 2017–Şubat 2021 tarihleri arasında kompleks renal tümör (PADUA skoru≥10) nedenli robotik parsiyel nefrektomi uygulanan 51 hasta retrospektif olarak çalışmaya dahil edilmiştir. 36 hastada çift kat renorrafi(Grup 1), 15 hastada FloSeal® (Baxter Medical, Fremont, CA) hemostatik ajan eşliğinde tek kat renorrafi (Grup 2) uygulanmıştır. Pre- ve post-operatif serum kreatinin, glomerüler filtrasyon hızı ve hemoglobin düzeyleri, cerrahi ve sıcak iskemi süreleri, dren ve hastanede kalış süreleri, komplikasyonlar değerlendirildi.
Bulgular: Hastaların ortalama yaşı 50 olup kadın/erkek oranı 18/33’dü. Grup 1 ve Grup 2 ortalama PADUA skorları sırasıyla 11 ve 10.47 hesaplandı. Pre-, post-operatif 1.gün ve 6.ay ortalama serum kreatinin değerleri Grup 1’de sırasıyla 1.02, 1.15 ve 1.09 mg/dL olup Grup 2’de 0.93, 1.02 ve 0.90 mg/dL’idi. Pre-, post-operatif 1.gün ve 6.ay ortalama GFR değerleri Grup 1 ‘de sırasıyla 91.47, 77.31 ve 81.90 mL/dk/1.73m2 olup Grup 2’de 92.07, 84.93 ve 90.73 mL/dk/1.73m2 ‘idi. Pre- ve post-operatif hemoglobin değerleri de karşılaştırıldı. Operasyon ve sıcak iskemi süreleri sırasıyla Grup 1’de 118 ve 23 dk iken Grup 2’de 101 ve 13 dk olarak kaydedildi. Gruplar arasında dren ve hastanede kalış süreleri açısından anlamlı fark izlenmedi. Perioperatif sadece Clavian I ve II komplikasyonlar izlendi. Takipte herhangi nüks izlenmedi.
Sonuç: Robotik parsiyel nefrektomi uygulanan PADUA skoru 10-11 arasındaki kompleks tümörlerde hemostatik ajan eşliğinde tek kat renorrafi güvenle uygulanabilir.

Keywords

Robotik parsiyel nefrektomi , Nefron koruyucu cerrahi , Renorrafi , Kompleks renal tümör

References

• 1. Ljungberg B, Albiges L, Abu-Ghanem Y, et al. European Association of Urology Guidelines on Renal Cell Carcinoma: The 2019 Update. European urology. 2019;75(5):799-810.
• 2. Karellas ME, O'Brien MF, Jang TL, Bernstein M, Russo P. Partial nephrectomy for selected renal cortical tumours of >/= 7 cm. BJU Int. 2010;106(10):1484-7.
• 3. Mir MC, Ercole C, Takagi T, et al. Decline in renal function after partial nephrectomy: etiology and prevention. The Journal of urology. 2015;193(6):1889-98.
• 4. Lavery HJ, Small AC, Samadi DB, Palese MA. Transition from laparoscopic to robotic partial nephrectomy: the learning curve for an experienced laparoscopic surgeon. JSLS. 2011;15(3):291-7.
• 5. Bertolo R, Campi R, Mir MC, et al. Systematic Review and Pooled Analysis of the Impact of Renorrhaphy Techniques on Renal Functional Outcome After Partial Nephrectomy. Eur Urol Oncol. 2019;2(5):572-5.
• 6. Li CC, Yeh HC, Lee HY, et al. Laparoscopic partial nephrectomy without intracorporeal suturing. Surg Endosc. 2016;30(4):1585-91.
• 7. Ficarra V, Novara G, Secco S, et al. Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. European urology. 2009;56(5):786-93.
• 8. Benway BM, Cabello JM, Figenshau RS, Bhayani SB. Sliding-clip renorrhaphy provides superior closing tension during robot-assisted partial nephrectomy. Journal of endourology / Endourological Society. 2010;24(4):605-8.
• 9. Ghani KR, Sukumar S, Sammon JD, Rogers CG, Trinh QD, Menon M. Practice patterns and outcomes of open and minimally invasive partial nephrectomy since the introduction of robotic partial nephrectomy: results from the nationwide inpatient sample. The Journal of urology. 2014;191(4):907-12.
• 10. Benway BM, Wang AJ, Cabello JM, Bhayani SB. Robotic partial nephrectomy with sliding-clip renorrhaphy: technique and outcomes. European urology. 2009;55(3):592-9.
• 11. Williams RD, Snowden C, Frank R, Thiel DD. Has Sliding-Clip Renorrhaphy Eliminated the Need for Collecting System Repair During Robot-Assisted Partial Nephrectomy? Journal of endourology / Endourological Society. 2017;31(3):289-94.
• 12. Shatagopam K, Bahler CD, Sundaram CP. Renorrhaphy techniques and effect on renal function with robotic partial nephrectomy. World J Urol. 2020;38(5):1109-12.
• 13. Bahler CD, Cary KC, Garg S, et al. Differentiating reconstructive techniques in partial nephrectomy: a propensity score analysis. Can J Urol. 2015;22(3):7788-96.
• 14. Bahler CD, Dube HT, Flynn KJ, et al. Feasibility of omitting cortical renorrhaphy during robot-assisted partial nephrectomy: a matched analysis. Journal of endourology / Endourological Society. 2015;29(5):548-55.
• 15. Porpiglia F BR, Amparore D, et al. Single-layer versus double-layer renorrhaphy during minimally-invasive partial nephrectomy: Are there effects on renal function? 2016.
• 16. Antonelli A, Minervini A, Mari A, et al. TriMatch comparison of the efficacy of FloSeal versus TachoSil versus no hemostatic agents for partial nephrectomy: results from a large multicenter dataset. Int J Urol. 2015;22(1):47-52.
• 17. Wille AH, Johannsen M, Miller K, Deger S. Laparoscopic partial nephrectomy using FloSeal for hemostasis: technique and experiences in 102 patients. Surg Innov. 2009;16(4):306-12.