Effect of vertical-cross suture technique for the renal defect in Robot-assisted laparoscopic partial nephrectomy (Report of 76 cases)

Liu Qiming; Gao Yu; Ma Xin; Li Hongzhao; Wang Baojun; Zhang Xu

doi:10.19558/j.cnki.10-1020/r.2018.03.003

Abstract：Objective:To investigate the technique and results of vertica-l cross suture for the renal defect in Robot-assisted laparoscopic partial nephrectomy.Methods:Robot-assisted laparoscopic partial nephrectomy was performed on 76 cases of renal tumor from Mar.2015 to Mar.2016.Different approaches (transperitoneal/retro-peritoneal)were adopted according to different tumor sites (ventral/dorsal).The renal tumor was fully mobilized in perinephric fat.Renal artery was exposed in the vessel-free space between the perinephric fat and psoas major. The tumor was completely resected along the pseudocapsule sharply and bluntly.For the large renal defect,the novel vertical-cross suture by barbed thread was used.The operation time,warm ischemia time,estimated blood loss,complications during and after operation and the operative efficacy were observed.Results:All the operations were successfully completed.No radical nephrectomy and open surgery conversion were done.The median opera-tive time was 90 min (60-140 min),median warm ischemia time was 18 min (16-24 min)and median estimated blood loss was 50 mL (20-150 mL).No transfusion occured during and after the operation.There were no post-op-erative hematuria,urine leakage,aeterial-venous fistula,pseudoaneurysm and other severe complications.All the cases achieved negative surgical margin.Pathologically,there were 6 9 cases of clear cell renal cell carcinoma,2 ca-ses of chromophobe renal carcinoma,and 5 cases of angiomyolipomas.Conclusions:Vertical-cross suture by barbed thread is safe and feasible for the renal defect.It is effective in prevention of post-operative bleeding,urine leakage and pseudoaneurysm.