Comparison of robot-assisted partial nephrectomy with soft coagulation and double-layer technique for complex and non-complex tumors.

Abstract

OBJECTIVES:

To compare the postoperative outcomes of robot-assisted partial nephrectomy when only the inner layer is sutured (single-layer technique with soft coagulation) with those when sutures are placed in the inner and outer layers (double-layer technique) in patients with and without complex renal tumors.

METHODS:

This retrospective three-institution study included 371 patients with renal tumors who underwent robot-assisted partial nephrectomy with a double-layer technique or a single-layer technique with soft coagulation. Tumors that were cT1b, completely embedded, located in the renal portal, or had a RENAL score of ≥10 were considered complex. Relevant data were collected from hospital records. Propensity score matching was performed to minimize selection bias.

RESULTS:

Propensity score matching created 83 patient pairs with non-complex tumors and 32 with complex tumors. Regardless of tumor complexity, there was no significant difference in operation time, console time, warm ischemia time, positive surgical margin rate, or length of hospital stay between the double-layer and single-layer groups. Although Clavien-Dindo grade I-II urinomas not requiring intervention were significantly more common in the single-layer group regardless of tumor complexity, there was no significant between-group difference in the rate of decline in renal function or grade III-IV complications.

CONCLUSION:

Single-layer suturing with soft coagulation achieves renal function and perioperative outcomes comparable to those of double-layer suturing regardless of complexity.

• Authors: Keito Shiozaki, Kazuyoshi Izumi, Yutaro Sasaki, Yoshito Kusuhara, Tomoya Fukawa, Yasuyo Yamamoto, Kunihisa Yamaguchi, Hirofumi Izaki, Masayuki Takahashi, Yasuo Kawanishi, Hiroomi Kanayama
• Journal: International journal of urology : official journal of the Japanese Urological Association (Int J Urol) Vol. 30 Issue 3 Pg. 281-288 (03 2023) ISSN: 1442-2042 [Electronic] Australia
• PMID: 36448456 (Publication Type: Journal Article)
• Copyright: © 2022 The Japanese Urological Association.

Topics

• Humans
• Robotics
• Retrospective Studies
• Nephrectomy (methods)
• Kidney (surgery)
• Kidney Neoplasms (pathology)
• Robotic Surgical Procedures (methods)
• Treatment Outcome