Preventive sutures in nonischemic laparoscopic partial nephrectomy. Description of S.P. Botkin City Clinical Hospital technique

Background. Radical removal of the tumor while maximizing sparing of the renal function are the main goals of the partial nephrectomy. Shortening of the warm ischemia time is one of the best ways to achieve good functional results of the surgery. Aim. To present our technique of non-ischemic laparoscopic kidney resection with preventive suturing around the tumor.

Materials and methods. Before tumor resection, sutures are placed around tumor spaced by 1 cm with moderate tension. Enucleoresection is performed between tumor and preplaced sutures in visually healthy plane. 30 patients underwent this technique.

Results. Median tumor size was 3.6 (1.5–7.2) cm. All patients had negative surgical margin. Warm ischemia was needed in 8 (26.7 %) patients with a median time of 9 minutes. Median operative time was 115 (65–185) minutes. There were no intra or postoperative complications. Trifecta was achieved in all patients (100 %).

Conclusion. This technique allows to perform the surgery in non-ischemic fashion, decrease bleeding and improve visualization of the resection field and achieve superior oncologic and functional results.

1. Seregin A.V., Shustitsky N.A. Nephron­sparing surgery in kidney cancer: surgical technique. Consilium Medicum 2012;14(7):63–6. (In Russ.).

2. Loran O.B., Seregin A.V., Shustitsky N.A. Technical peculiarities during organ­preserving surgery for kidney cancer. Meditsinskiy vestnik Bashkortostana = Bashkortostan Medicine Herald 2013;8(2):197–201. (In Russ.).

3. Seregin A.V., Shustitsky N.A., Indarokov T.R. et al. Partial nephrectomy with preventive sutures for renal cell carcinoma. Annaly khirurgii = Annalls of Surgery 2016;21:235–9. (In Russ.). DOI: 10.18821/1560­9502­2016­214­235­239

4. Rizkala E.R., Khalifeh A., Autorino R. et al. Zero ischemia robotic partial nephrectomy: sequential preplaced suture renorrhaphy technique. Urology 2013;82(1):100–4. DOI: 10.1016/j.urology.2013.03.042

5. Lu J., Zu Q., Du Q. et al. Zero ischaemia laparoscopic nephron­sparing surgery by re­suturing. Contemp Oncol (Pozn) 2014;18(5):355–8. DOI: 10.5114/wo.2014.41385

6. Sönmez M.G., Kara C. The effect of zero­ischaemia laparoscopic minimally invasive partial nephrectomy using the modified sequential preplaced suture renorrhaphy technique on long­term renal functions. Wideochir Inne Tech Maloinwazyjne 2017;12(3):257–63. DOI: 10.5114/wiitm.2017.67136