A New Renorrhaphy Technique Using Barbed Sutures and Elongated Pledgets for Robotic Partial Nephrectomy

Area of Science:

• Urology
• Surgical Innovation
• Minimally Invasive Surgery

Background:

• Robot-assisted partial nephrectomy (RAPN) presents challenges in achieving effective hemostasis and renorrhaphy.
• Intracorporeal suturing techniques are crucial for successful RAPN outcomes.

Purpose of the Study:

• To evaluate a novel RAPN approach using renorrhaphy with barbed sutures (BSs) and elongated pledgets (R-BEP).
• To assess the safety and efficacy of the R-BEP technique in complex partial nephrectomies.

Main Methods:

• The R-BEP procedure involves single-layer running monofilament absorbable barbed sutures for renal parenchyma closure.
• Elongated polytetrafluoroethylene (PTFE) pledgets reinforce the suture line, with bites placed 3-5 mm apart.
• Barbed sutures maintain tension throughout the single-suture closure.

Main Results:

• The R-BEP procedure was performed on 55 patients, with 69.1% having high RENAL scores (≥7).
• Complete hemostasis and urostasis were achieved in all patients without additional procedures.
• Mean operative time was 183.3 minutes, and mean warm ischemia time was 22.5 minutes, with no major intraoperative bleeding or conversions to open surgery.

Conclusions:

• The R-BEP procedure is safe and effective for complex renal tumors in RAPN.
• This technique improves surgical workflow and yields satisfactory outcomes in minimally invasive partial nephrectomy.
• The R-BEP approach addresses technical challenges in renorrhaphy for robot-assisted surgery.