Feasibility of omitting cortical renorrhaphy during robot-assisted partial nephrectomy: A matched analysis

Clinton D. Bahler, Hitesh T. Dube, Kevin J. Flynn, Swapnil Garg, M. Francesca Monn, Luke G. Gutwein, Matthew J. Mellon, Richard S. Foster, Liang Cheng, M. Kumar Sandrasegaran, Chandru P. Sundaram

Research output: Contribution to journalArticle

28 Scopus citations

Abstract

To assess the safety of omitting cortical renorrhaphy during robot-assisted partial nephrectomy and measure preliminary functional outcomes. Patients and Methods: Fifteen robot-assisted partial nephrectomies were performed with a running, base-layer suture for the collecting system and vessel hemostasis but without cortical renorrhaphy. The nonrenorrhaphy group was matched 1:2 by R.E.N.A.L. nephrometry score to a running, sliding-clip cortical renorrhaphy group retrospectively. Intraoperative blood loss, urine leaks, postoperative bleeds, and functional outcomes were evaluated. Predictors of %volume loss were evaluated using multivariable regression. Results: No differences were seen between renorrhaphy and nonrenorrhaphy in sex (P=0.53), age (P=0.14), body mass index (P=0.08), Charlson score (P=0.44), tumor diameter (P=0.55), nephrometry score (P=0.77), preoperative glomerular filtration rate (GFR, P=0.63), or the amount of resected healthy kidney margin (P=0.21). Warm ischemia time was less for the nonrenorrhaphy group (P<0.002). One pseudoaneurysm necessitating embolization (1/30=3%) was seen in the renorrhaphy group compared with none in the nonrenorrhaphy group. No urine leaks occurred in either group. The median %GFR loss was 8.8% for renorrhaphy and 4.4% for nonrenorrhaphy (P=0.14) at a median follow-up of 4.1 months. The median %volume loss was 17 cm3 for renorrhaphy and 9 cm3 for nonrenorrhaphy (P=0.003). In a multivariable model, both cortical renorrhaphy (P=0.004) and tumor diameter (P=0.004) were predictors of %volume loss. Conclusion: Omission of cortical renorrhaphy appears feasible with no urine leaks or bleeding complications observed. The percent renal volume loss was improved by omission of cortical renorrhaphy. Reconstruction technique is important to control for when studying renal function after partial nephrectomy.

Original languageEnglish (US)
Pages (from-to)548-555
Number of pages8
JournalJournal of Endourology
Volume29
Issue number5
DOIs
StatePublished - May 1 2015

    Fingerprint

ASJC Scopus subject areas

  • Urology

Cite this