Korean J Urol.  2015 Nov;56(11):762-768. 10.4111/kju.2015.56.11.762.

The clinical application of the sliding loop technique for renorrhaphy during robot-assisted laparoscopic partial nephrectomy: Surgical technique and outcomes

• Kim HS
• Lee YJ
• Ku JH
• Kwak C
• Kim HH
• Jeong CW

• KMID: 2351039
• DOI: http://doi.org/10.4111/kju.2015.56.11.762

Abstract

PURPOSE
To report the initial clinical outcomes of the newly devised sliding loop technique (SLT) used for renorrhaphy in patients who underwent robot-assisted laparoscopic partial nephrectomy (RALPN) for small renal mass.
MATERIALS AND METHODS
We reviewed the surgical videos and medical charts of 31 patients who had undergone RALPN with the SLT renorrhaphy performed by two surgeons (CWJ and CK) between January 2014 and October 2014. SLT renorrhaphy was performed after tumor excision and renal parenchymal defect repair. Assessed outcomes included renorrhaphy time (RT), warm ischemic time, perioperative complications, and perioperative renal function change. RT was defined as interval from the end of bed suture to the renal artery declamping.
RESULTS
In all patients, sliding loop renorrhaphy was successfully conducted without conversions to radical nephrectomy or open approaches. Mean renorrhaphy and warm ischemic time were 9.0 and 22.6 minutes, respectively. After completing renorrhaphy, there were no adverse events such as dehiscence of approximated renal parenchyma, renal parenchymal tearing, or significant bleeding. Furthermore, no postoperative complications or significant renal function decline were observed as of the last follow-up for all patients. The limitations of this study include the small volume case series, the retrospective nature of the study, and the heterogeneity of surgeons.
CONCLUSIONS
From our initial clinical experience, SLT may be an efficient and safe renorrhaphy method in real clinical practice. Further large scale, prospective, long-term follow-up, and direct comparative studies with other techniques are required to confirm the clinical applicability of SLT.

Keyword

Nephrectomy; Renorrhphy; Small renal mass; Technique

MeSH Terms

Adult
Aged
Female
Hemostasis, Surgical/methods
Humans
Kidney Neoplasms/*surgery
Laparoscopy/methods
Male
Middle Aged
Nephrectomy/*methods
Patient Positioning/methods
Robotic Surgical Procedures/*methods
*Suture Techniques
Treatment Outcome

Figure

• 

  Fig. 1 The placement and location of trocars in our four arm approach robot-assisted laparoscopic partial nephrectomy (right side). C, trocar for camera; R1, robotic trocar for 1st arm; R2, robotic trocar for 2nd arm; R3, robotic trocar for 3rd arm; A1, 12-mm trocar for assistant; A2, 5-mm trocar for assistant.

• 

  Fig. 2 Brief description of renal reconstruction. (A) The repair of renal parenchymal defect with continuous running suture using 3-0 V-Loc unidirectional barbed suture material. (B) After each suture material is placed through renal capsule, the needle passes through pre-made loop. (C) Weck Hem-O-Lok (Teleflex, Research Triangle, NC, USA) clip is placed along the thread and the clip is pushed toward the renal parenchyma to obtain adequate tension. (D) LapraTy (Ethicon Inc., Cincinnati, OH, USA) clip is added to prevent Weck clips from sliding back and to preserve tension. Scan this QR code to see the accompanying video, or visit www.kjurology.org or http://youtu.be/UCxubKQxQzA.

• 

  Fig. 3 Suture material designed for sliding loop renorrhaphy. 1-0 Vicryl (approximately 13-cm-long length) with a loop at the end of the thread. A TFE polymer pledget (Ethicon Inc, Somerville, NJ, USA) and a 10-mm Weck Hem-O-Lok (Teleflex, Research Triangle, NC, USA) is placed below the knot.

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