Abstract
Objective
To evaluate the efficacy of the self-retaining barbed suture (SRBS) in renal defect repair during partial nephrectomy (PN), by assessing perioperative outcomes.
Methods
From June 2010 on we have been using the SRBS for superficial layer closure during open and laparoscopic PN in two European centers. These data were collected prospectively and matched with historical PN cases performed with conventional suture. Cases were matched for PADUA score, surgical approach (laparoscopic or open) and the center where surgery was performed. Comparisons were made in patient characteristics and perioperative outcomes including warm ischemia time (WIT), changes in hemoglobin (Hb), changes in estimated glomerular filtration rate (eGFR) and perioperative complications between the SRBS and non-SRBS groups. Statistical tests of significance were performed using Student’s t test and chi-square test for continuous and categorical variables, respectively.
Results
Thirty-one consecutive cases of PN under WIT were performed with SRBS. These cases were matched with cases from the historical database of PN performed with conventional suture. The rate of perioperative complications was statistically significantly lower in the SRBS cohort (6.5 vs. 22.6 %, p = 0.038). Mean ischemia time was 19.6 min (SD, 7.5) in the SRBS group versus 21.8 min (SD, 9.5) in the conventional suture group (p = 0.312). There were no significant differences between groups for postoperative changes in creatinine, eGFR and Hb. Limitations of this study include the absence of randomization and the relative small sample size.
Conclusions
SRBS can be safely used during partial nephrectomy. SRBS reduces significantly the number of perioperative complications.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Campbell S, Novick A, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279
Ljungberg B, Cowan N, Hanbury D et al (2010) EAU guidelines on renal cell carcinoma: the 2010 update. Eur Urol 58:398–406
Patard J, Pantuck A, Crepel M et al (2007) Morbidity and clinical outcome of nephron-sparing surgery in relation to tumour size and indication. Eur Urol 52:148–154
Van Poppel H, Da Pozzo L, Albrecht W et al (2007) A prospective randomized EORTC intergroup phase 3 study comparing the complications of elective nephron-sparing surgery and radical nephrectomy for low-stage renal cell carcinoma. Eur Urol 51:1606–1615
Thompson RH, Frank I, Lohse C et al (2007) The impact of ischemia time during open nephron sparing surgery on solitary kidneys: a multi-institutional study. J Urol 177:471–476
Becker F, Van Poppel H, Hakenberg H et al (2009) Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol 56:625–635
Thompson RH, Lane B, Lohse C et al (2010) Every minute counts when the renal hilum is clamped during partial nephrectomy. Eur Urol 58:340–345
Lane B, Gill I, Fergany A et al (2011) Limited warm ischemia during elective partial nephrectomy has only a marginal impact on renal functional outcomes. J Urol 185:1598–1603
Gill I, Kavoussi L, Lane B et al (2007) Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol 178:41–46
Sprenkle PC, Power N, Ghoneim T et al (2012) Comparison of open and minimally invasive partial nephrectomy for renal tumors 4–7 centimeters. Eur Urol 61:593–599
Villa M, White L, Alam M et al (2008) Barbed sutures: a review of the literature. Plast Reconstr Surg 121:102e–108e
Greenberg J, Clark R (2009) Advances in suture material for obstetric and gynecologic surgery. Rev Obstet Gynecol 2:146–158
Shikanov S, Wille M, Large M et al (2009) Knotless closure of the collecting system and renal parenchyma with a novel barbed suture during laparoscopic porcine partial nephrectomy. J Endourol 23:1157–1160
Moran M, Marsh C, Perrotti M (2007) Bidirectional-barbed sutured knotless running anastomosis v classic Van Velthoven suturing in a model system. J Endourol 21:1175–1177
Tewari A, Srivastava A, Sooriakumaran P et al (2010) Use of a novel absorbable barbed plastic surgical suture enables a “self-cinching” technique of vesicourethral anastomosis during robot-assisted prostatectomy and improves anastomotic times. J Endourol 24:1645–1650
Kaul S, Sammon J, Bhandari A et al (2010) A novel method of urethrovesical anastomosis during robot-assisted radical prostatectomy using a unidirectional barbed wound closure device: feasibility study and early outcomes in 51 patients. J Endourol 24:1789–1793
Williams S, Alemozaffar M, Lei Y et al (2010) Randomized controlled trial of barbed polyglyconate versus polyglactin suture for robot-assisted laparoscopic prostatectomy anastomosis: technique and outcomes. Eur Urol 58:875–881
Sammon J, Petros F, Sukumar S et al (2011) Barbed suture for renorrhaphy during robot-assisted partial nephrectomy. J Endourol 25:529–533
Olweny E, Park S, Seideman A et al (2011) Self-retaining barbed suture for parenchymal repair during laparoscopic partial nephrectomy; initial clinical experience. BJU Int 109:906–909
Nguyen M, Gill I (2008) Halving ischemia time during laparoscopic partial nephrectomy. J Urol 179:627–632
Gill I, Kamoi K, Aron M et al (2010) 800 Laparoscopic partial nephrectomies: a single surgeon series. J Urol 183:34–42
Gill I, Eisenberg M, Aron M et al (2011) “Zero ischemia” partial nephrectomy: novel laparoscopic and robotic technique. Eur Urol 59:128–134
Ficarra V, Novara G, Secco S et al (2009) Preoperative aspects and dimensions used for an anatomical (PADUA) classification of renal tumours in patients who are candidates for nephron-sparing surgery. Eur Urol 56:786–793
Charlson M, Pompei P, Ales K et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383
Stevens L, Levey A (2009) Use of the MDRD study equation to estimate kidney function for drug dosing. Clin Pharmacol Ther 86:465–467
Dindo D, Demartines N et al (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213
Breda A, Finelli A, Janetschek G et al (2009) Complications of laparoscopic surgery for renal masses: prevention, management, and comparison with the open experience. Eur Urol 55:836–850
OCEBM Levels of Evidence Working Group (2011) The Oxford 2011 levels of evidence. Oxford Centre for Evidence-Based Medicine
Seideman C, Park S, Best S et al (2011) Self-retaining barbed suture for parenchymal repair during minimally invasive partial nephrectomy. J Endourol 25:1245–1247
Conflict of interest
The authors declare that they have no conflict of interest.
Author information
Authors and Affiliations
Corresponding author
Additional information
Patricia J. Zondervan and Ali S. Gozen have equally contributed to this work.
Rights and permissions
About this article
Cite this article
Zondervan, P.J., Gozen, A.S., Opondo, D. et al. Partial nephrectomy: Is there an advantage of the self-retaining barbed suture in the perioperative period? A matched case–control comparison. World J Urol 30, 659–664 (2012). https://doi.org/10.1007/s00345-012-0933-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00345-012-0933-y