Riccardo Bertolo1, Riccardo Campi2, Tobias Klatte3, Maximilian C Kriegmair4, Maria Carmen Mir5, Idir Ouzaid6, Maciej Salagierski7, Sam Bhayani8, Inderbir Gill9,10, Jihad Kaouk1, Umberto Capitanio8,9,11,12. 1. Department of Urology, Cleveland Clinic Foundation, Cleveland, OH, USA. 2. Department of Urology, University of Florence, Florence, Italy. 3. Department of Urology, Royal Bournemouth and Christchurch Hospitals, Bournemouth, UK. 4. Department of Urology, University Medical Centre Mannheim, Mannheim, Germany. 5. Department of Urology, Fundacion Instituto Valenciano de Oncologia, Valencia, Spain. 6. Department of Urology, Bichat Hospital, APHP, Paris Diderot University, Paris, France. 7. Urology Department, Faculty of Medicine and Health Sciences, University of Zielona Góra, Zielona Góra, Poland. 8. Division of Urology, Washington University School of Medicine, St Louis, MO, USA. 9. Keck School of Medicine, USC Institute of Urology, University of Southern California, Los Angeles, CA, USA. 10. Catherine and Joseph Aresty Department of Urology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. 11. Department of Urology, San Raffaele Scientific Institute, Milan, Italy. 12. Division of Experimental Oncology/Unit of Urology, URI, IRCCS San Raffaele Hospital, Milan, Italy.
Abstract
OBJECTIVE: To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri-operative outcomes after minimally invasive partial nephrectomy (MIPN). MATERIALS AND METHODS: A systematic review of the literature was performed in January 2018 without time restrictions, using MEDLINE, Cochrane and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Studies providing sufficient details on renorrhaphy techniques during laparoscopic or robot-assisted partial nephrectomy and comparative studies focused on peri-operative outcomes were included in qualitative and quantitative analyses, respectively. RESULTS: Overall, 67 and 19 studies were included in the qualitative and quantitative analyses, respectively. The overall quality of evidence was low. Specific tumour features (i.e. size, hilar location, anatomical complexity, nearness to renal sinus and/or urinary collecting system), surgeon's experience, robot-assisted technology, as well as the aim of reducing warm ischaemia time and the amount of devascularized renal parenchyma preserved represented the key factors driving the evolution of the renorrhaphy techniques during MIPN over the past decade. Quantitative synthesis showed that running suture was associated with shorter operating and ischaemia time, and lower postoperative complication and transfusion rates than interrupted suture. Barbed suture had lower operating and ischaemia time and less blood loss than non-barbed suture. The single-layer suture technique was associated with shorter operating and ischaemia time than the double-layer technique. No comparisons were possible concerning renal functional outcomes because of non-homogeneous data reporting. CONCLUSIONS: Renorrhaphy techniques significantly evolved over the years, improving outcomes. Running suture, particularly using barbed wires, shortened the operating and ischaemia times. A further advantage could derive from avoiding a double-layer suture.
OBJECTIVE: To summarize the available evidence on renorrhaphy techniques and to assess their impact on peri-operative outcomes after minimally invasive partial nephrectomy (MIPN). MATERIALS AND METHODS: A systematic review of the literature was performed in January 2018 without time restrictions, using MEDLINE, Cochrane and Web of Science databases according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement recommendations. Studies providing sufficient details on renorrhaphy techniques during laparoscopic or robot-assisted partial nephrectomy and comparative studies focused on peri-operative outcomes were included in qualitative and quantitative analyses, respectively. RESULTS: Overall, 67 and 19 studies were included in the qualitative and quantitative analyses, respectively. The overall quality of evidence was low. Specific tumour features (i.e. size, hilar location, anatomical complexity, nearness to renal sinus and/or urinary collecting system), surgeon's experience, robot-assisted technology, as well as the aim of reducing warm ischaemia time and the amount of devascularized renal parenchyma preserved represented the key factors driving the evolution of the renorrhaphy techniques during MIPN over the past decade. Quantitative synthesis showed that running suture was associated with shorter operating and ischaemia time, and lower postoperative complication and transfusion rates than interrupted suture. Barbed suture had lower operating and ischaemia time and less blood loss than non-barbed suture. The single-layer suture technique was associated with shorter operating and ischaemia time than the double-layer technique. No comparisons were possible concerning renal functional outcomes because of non-homogeneous data reporting. CONCLUSIONS: Renorrhaphy techniques significantly evolved over the years, improving outcomes. Running suture, particularly using barbed wires, shortened the operating and ischaemia times. A further advantage could derive from avoiding a double-layer suture.
Authors: A W Silagy; R Young; B D Kelly; F Reeves; M Furrer; A J Costello; B J Challacombe; N M Corcoran; J Kearsley; P Dundee; D K Agarwal Journal: BJUI Compass Date: 2021-03-12