Bipolar electrocautery hemostasis in sutureless laparoscopic partial nephrectomy for exophytic small renal masses...

The rising detection of small renal masses (SRMs) has heightened the demand for minimally invasive, nephron-sparing surgical strategies. Sutureless laparoscopic partial nephrectomy (LPN) without renal artery clamping avoids ischemia-reperfusion injury (IRI) and preserves renal function, but achieving effective hemostasis is challenging. Bipolar electrocautery can offer reliable hemostasis via localized thermal coagulation, potentially enabling sutureless reconstruction. This retrospective study investigated the feasibility and safety of bipolar electrocautery hemostasis for sutureless LPN for exophytic SRMs without renal artery clamping.

The study included 66 patients who underwent LPN without renal artery clamping for exophytic SRMs between August 2016 and April 2023. Patients were assigned to the suture group (n=42) or the sutureless group (n=24) based on intraoperative hemostatic strategy: barbed suture repair versus bipolar electrocautery. Baseline characteristics, perioperative data, and postoperative outcomes were compared. Generalized linear models (GLM) were used to perform multivariable adjustment for potential confounders including maximum tumor diameter, preoperative hemoglobin (Hb), serum creatinine (SCr), and glomerular filtration rate (GFR).

All surgical procedures were performed laparoscopically without renal artery clamping. Baseline characteristics were generally comparable between groups. Within-group analysis showed significant postoperative decreases in Hb and GFR in both groups (P<0.05), while SCr increased significantly only in the suture group (P<0.05). After multivariable adjustment, the sutureless group was associated with shorter operative time (100.82 vs. 116.26 min, P=0.04), lower postoperative SCr (69.10 vs. 75.81 µmol/L, P=0.04), higher preserved postoperative GFR (47.61 vs. 45.25 mL/min, P<0.001), and a smaller reduction in GFR (2.97 vs. 5.32 mL/min, P<0.001). However, the sutureless group was associated with higher intraoperative blood loss (154.28 vs. 89.59 mL, P=0.003). Other perioperative outcomes were comparable between groups. All surgical margins were negative, and no short-term tumor recurrence was observed in either group.

In selected patients with exophytic SRMs, bipolar electrocautery hemostasis during sutureless LPN performed under zero-ischemia may be feasible and is associated with a shorter operative time, a smaller early postoperative decline in renal function, and no increase in short-term complications. However, this non-randomized retrospective study has inherent limitations, such as potential temporal bias from the later introduction of the sutureless technique. These findings are hypothesis-generating and require confirmation in larger prospective randomized controlled studies.