Introduction: In the last years, sutureless approach has gaining popularity for its feasibility and safety, together with promising functional outcomes and shorter operative time and length of stay compared to renorraphy technique. In this video we describe surgical steps, perioperative and short term functional outcomes of sutureless off clamp robotic partial nephrectomy.
Methods: This was the case of an endophytic 3 cm left renal mass (RENAL score: 9). Preoperatively, a mixture of lipiodol and indocyanine green was delivered transarterially to mark the lesion. Gerota's capsule was opened and NIRF was used to easily locate the tumor. Tumor margins were scored with monopolar coagulation, following ICG guidance to define tumor edges. The enucleation plane was progressively developed, cauterizing all arterial feeders. Two suction devices with irrigation were used simultaneously to maximize the visualization of the enucleation plane developed following the ICG guidance. Monopolar coagulation of the resection bed started from the outer part of the cortical layer, moving inwards to the renal medulla. Once haemostasis was achieved, near infrared fluorescence was used to inspect renal parenckhyma perfusion. Renal capsule was closed with hem-o-lok and a drain was left in place. Perioperative outcomes were compared to a propensity score matched cohort of renorraphy cases.
Results: 180 procedures over 548 were sutureless. Trifecta achievement rate was significantly higher in the sutureless group (93% vs 83%). A propensity score matched analysis, generated 2 cohorts of 80 patients homogeneous for age, gender, ASA score, baseline eGFR, tumor size and surgical complexity.Patients receiving sutureless partial nephrectomy had shorter hospital stay, negligible complications and increased likelihood of achieving Trifecta. Kaplan Maier analysis showed significant CKD stage migration free survival probabilities comparable between groups.
Conclusions: Patients receiving sutureless off-clamp robotic partial nephrectomy had negligible complications and minimal incidence of perioperative renal function impairment. This approach increased the probability to achieve the Trifecta compared to renorraphy cohort. further studies are needed to assess long-term outcomes.