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

Effective hemostasis and renorrhaphy with intracorporeal suturing are major technical challenges in robot-assisted partial nephrectomy (RAPN). This report outlines the authors' experience with a novel RAPN approach using renorrhaphy with barbed sutures (BSs) and elongated pledgets (R-BEP) in a video.

The R-BEP procedure comprised several steps, including a single layer of monofilament adsorbable running BSs used to close the renal parenchyma, reinforced by elongated polytetrafluoroethylene (PTFE) pledgets. Two PTFE pledgets, approximately 8 to 10 mm in width, were cut to match the resection bed. Suturing began at one end of the resection bed, with bites placed 3 to 5 mm apart. The BSs maintained tension throughout the single-suture bites.

The RAPN procedure with R-BEP was performed for 55 patients, including 38 (69.1%) patients with a RENAL score of 7 or higher. The mean operation time was 183.3 ± 51.3 min, and the mean warm ischemia time was 22.5 ± 9.6 min. Complete hemostasis and urostasis were achieved for all the patients without the need for additional clamping or procedures for renorrhaphy. No patient was converted to laparoscopic or open surgery or experienced major intraoperative bleeding. Postoperatively, one patient experienced urinary leakage, which was successfully managed with a ureteral stent. No postoperative bleeding, reoperation, or mortality were reported.

The R-BEP procedure was safe and effective for the treatment of complex renal tumors with a high RENAL score using minimally invasive RAPN, improving the workflow and delivering satisfactory outcomes.