Citation: Journal of Endourology. 2020 Apr 22 [Epub ahead of print]
Author: Alrishan Alzouebi I, Williams A, Thiarajan NR, Kumar M
Abstract: INTRODUCTION: Preserving renal function after Robotic Assisted Partial Nephrectomy is important and influenced by the technique of renal reconstruction amongst other parameters including ischaemia time and amount of healthy renal tissue resected. It is believed that reconstruction with a second layer of cortical renorrhaphy is necessary to prevent urinary leaks and post-operative bleeding but this is associated with the potential loss of healthy renal parenchyma and may result in worse outcomes post-operatively.
PURPOSE: To assess the safety of omitting cortical renorrhaphy during RAPN .
PATIENTS AND METHODS: A retrospective analysis of 146 consecutive patients undergoing a robotic assisted partial nephrectomy with single or double layer renorrhaphy at the Wirral University Teaching Hospital from 2014-2019. Data obtained included: Patient demographics, tumour RENAL Nephrometry, Peri-operative parameters; blood loss, duration and warm ischaemia time, Post-op complications, change in eGFR (pre and 3 months post-op), length of stay and oncological outcomes.
RESULTS: In total 146 patients were identified. 106 had double renorrhaphy and 40 inner layer only renorrhaphy. No significant differences were seen between these two cohorts in terms of patient demographics, RENAL Nephrometry score, tumour size or location. Peri-operative parameters showed a reduced duration of surgery in the single renorrhaphy group with a mean of 125 minutes compared to143 minutes in the double renorrhaphy(p 0.006) and a tendency towards a shorter WIT of 12.9 minutes versus 14.0 minutes reaching borderline statistical significance (p 0.05) but no difference in blood loss volume (p 0.25). Post-operatively there was no statistical difference in the length of hospital stay (p 0.85), loss in eGFR at 3 months (0.06) or complication (p 0.56). After a median follow up of 35 months no recurrences or deaths were observed in either group. Conclusions Omission of cortical renorrhaphy appears feasible and safe with no urine leaks or excess complications observed.
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