Sutureless Purely Off-Clamp Robot-Assisted Partial Nephrectomy: Avoiding Renorrhaphy Does Not Jeopardize Surgical and...

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Robotic partial nephrectomy (RPN) is a standard treatment for renal masses.
• Sutureless (SL) techniques aim to simplify RPN, potentially improving outcomes.
• Renorrhaphy (RR) remains a common method for renorrhaphy closure.

Purpose of the Study:

• To compare the surgical outcomes of sutureless (SL) versus renorrhaphy (RR) in off-clamp robotic partial nephrectomy (ocRPN).
• To evaluate the impact of these techniques on trifecta achievement and renal function preservation.

Main Methods:

• Retrospective analysis of 531 patients undergoing ocRPN for cT1-2N0M0 renal masses (Jan 2017-Apr 2021).
• 1:1 propensity score-matched (PSM) analysis to compare SL and RR cohorts.
• Trifecta rate (negative margins, no positive margins, and no positive surgical margins) defined surgical quality.
• Significant chronic kidney disease stage migration (sCKDsm) and survival were assessed.

Main Results:

• After PSM, the SL group showed a significantly higher trifecta rate (94% vs. 84%; p = 0.007).
• No significant difference in sCKDsm-free survival (SMFS) was observed between SL and RR (log-rank = 0.69).
• Predictors of trifecta achievement included younger age, lower RENAL score, and SL approach; predictors of sCKDsm were older age and lower baseline eGFR.

Conclusions:

• The sutureless approach in ocRPN is associated with improved surgical quality, evidenced by a higher trifecta rate.
• Both SL and RR techniques demonstrate comparable renal function preservation in the short term.
• SL technique may be a valuable alternative for achieving optimal surgical outcomes in partial nephrectomy.