Sutureless robotic-assisted partial nephrectomy: a propensity score-matched analysis (UroCCR N.158).

Area of Science:

• Urology
• Surgical Oncology
• Nephrology

Background:

• Sutureless (SL) techniques offer an alternative to standard renorrhaphy (RR) in robot-assisted partial nephrectomy (RAPN).
• SL techniques aim to mitigate adverse effects of parenchymal suturing on renal function, particularly in off-clamp procedures.
• This study compares perioperative, functional, and oncological outcomes of SL versus RR in off-clamp RAPN.

Purpose of the Study:

• To compare the efficacy and safety of sutureless versus renorrhaphy techniques in off-clamp robot-assisted partial nephrectomy.
• To evaluate trifecta achievement, defined by negative surgical margins, absence of major complications, and preserved renal function.
• To assess the impact on perioperative outcomes, including blood loss and operative time.

Main Methods:

• A matched cohort study using data from the UroCCR database (June 2020 - March 2024).
• 410 off-clamp RAPN cases were analyzed, with 112 in the SL group and 298 in the RR group.
• Propensity score matching (2:1) based on R.E.N.A.L. nephrometry score was performed for comparison.

Main Results:

• After matching, 112 SL and 224 RR cases were compared.
• Trifecta achievement was significantly higher in the SL group (66.1% vs. 43.3%, P<0.001), driven by improved early renal function.
• SL group showed reduced blood loss (103 vs. 344 mL, P<0.001), shorter operative time (145 vs. 176 min, P=0.001), and fewer intraoperative complications (0.9% vs. 5.4%, P=0.04).

Conclusions:

• Omitting renorrhaphy in selected off-clamp RAPN cases is safe and effective.
• Sutureless techniques enhance early functional outcomes and reduce operative time.
• Perioperative morbidity is not increased, and oncological safety is maintained with sutureless approaches.