Sutureless partial nephrectomy

Introduction. A century and a half of experience in renal surgery has shown the clinical feasibility of preserving a functioning renal parenchyma and the pathogenetic validity of nephron-sparing surgery (NSS) in renal cell carcinoma (RCC).

Objective. To analyze the available scientific publications on nephron-sparing sutureless kidney surgery or without  so-called renorrhaphy.

Materials and methods. We have searched the eLibrary, PubMed, Сochrane Library and Scopus databases without time limits. A total of 19365 publications were found in the databases, including 71 randomized controlled clinical trials, 987 reviews of which 168 were systematic and 2 were performed based on data from the Cochrane Library. This review includes publications on the sutureless NSS technique in patients with RCC; clinical cases and abstracts were excluded from the formal analysis of publications. Thus, 132 publications were selected for the analysis, which are presented in the following independently or included in previous literature reviews. The studies available for analysis were quite heterogeneous in terms of patient groups, inclusion criteria, and control points, which did not allow for a meta-analysis of the data presented.

Results. An attempt to abandon the principle of kidney suturing after partial nephrectomy was implemented using methods of hemostasis based on the action of physical factors. At the same time, the value of any one of the methods that seemed at first glance did not show obvious unequivocal advantages in the NSS, the achievement of which would unequivocally reduce the severity of the problematic issue at the present stage. Significant prerequisites for such a state of the problem should be considered the monocentric nature of most studies and relatively little experience in the application of certain methods or their combinations. In the aspect of the foregoing, it is difficult to disagree with the statement that many different methods of hemostasis used during NSS appear not only to be the result of the tireless search for new opportunities by clinicians, but also the real lack of universal technologies.

Conclusion. An analysis of the advantages and disadvantages of the final hemostasis methods during NSS in patients with localized RCC indicates that this problem has not been solved and requires further research.

1. Nosov A.K., Lushina P.A., Petrov S.B. Laparoskokpicheskaya rezekciya pochki bez ishemii i bez nalozheniya gemostaticheskogo shva na zonu rezekcii u pacientov s rakom pochki. Urologicheskie vedomosti. 2016;6(S):76-77. (in Russ.) eLIBRARY ID: 26291166 EDN: WDIOOX

2. Nabi G, Cleves A, Shelley M. Surgical management of localised renal cell carcinoma. Cochrane Database Syst Rev. 2010;(3):CD006579. https://doi.org/10.1002/14651858.CD006579.pub2

3. Shormanov I.S., Los' M.S. Analysis of long-term results of protective therapy during the post-operative period after kidney resection due to renal cell carcinoma. Eksperimental'naya i klinicheskaya urologiya. 2017;(4):28-33. (In Russ.) eLIBRARY ID: 32362467 EDN: YNJPGK

4. Filimonova E.S., Aleshkevich A.I. Epidemiology of renal cell carcinoma and modern approaches to pathomorphological classification of urogenital system’s tumors (literature review). Issues of organization and information health. 2020;2(103):34-40. (In Russ.) eLIBRARY ID: 43310262 EDN: SCRAKR

5. Shkodkin S.V., Idashkin Yu.B., Fironov S.A., Fentisov V.V., Udovenko A.N. Kidney open resection in renal cell carcinoma. Urology Herald. 2018;6(2):54-61. (In Russ.) https://doi.org/10.21886/2308-6424-2018-6-2-54-61

6. Van Poppel H, Da Pozzo L, Albrecht W, Matveev V, Bono A, Borkowski A, Marechal JM, Klotz L, Skinner E, Keane T, Claessens I, Sylvester R; European Organization for Research and Treatment of Cancer (EORTC); National Cancer Institute of Canada Clinical Trials Group (NCIC CTG); Southwest Oncology Group (SWOG); Eastern Cooperative Oncology Group (ECOG). 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. 2007;51(6):1606-15. https://doi.org/10.1016/j.eururo.2006.11.013

7. Poulakis V, Witzsch U, de Vries R, Moeckel M, Becht E. Quality of life after surgery for localized renal cell carcinoma: comparison between radical nephrectomy and nephron-sparing surgery. Urology. 2003;62(5):814-20. https://doi.org/10.1016/s0090-4295(03)00687-3

8. Sanginov D.R., Zikriyahodzhaev D.Z., Saidov H.M., Nazhmidinov A.H., Muhiddinov U.R. Surgical tactics in renal-cell carcinoma. Vestnik poslediplomnogo obrazovaniya v sfere zdravoohraneniya. 2021;(3):72-77. (In Russ.) eLIBRARY ID: 47460381 EDN: WCMVYB

9. Mir MC, Derweesh I, Porpiglia F, Zargar H, Mottrie A, Autorino R. Partial Nephrectomy Versus Radical Nephrectomy for Clinical T1b and T2 Renal Tumors: A Systematic Review and Meta-analysis of Comparative Studies. Eur Urol. 2017;71(4):606-617. https://doi.org/10.1016/j.eururo.2016.08.060

10. Shah PH, Moreira DM, Patel VR, Gaunay G, George AK, Alom M, Kozel Z, Yaskiv O, Hall SJ, Schwartz MJ, Vira MA, Richstone L, Kavoussi LR. Partial Nephrectomy is Associated with Higher Risk of Relapse Compared with Radical Nephrectomy for Clinical Stage T1 Renal Cell Carcinoma Pathologically Up Staged to T3a. J Urol. 2017;198(2):289-296. https://doi.org/10.1016/j.juro.2017.03.012

11. Alyaev Yu.G., Bezrukov E.A., Sirota E.S., Shpot E.V., Proskura A.V. Methods of hemostasis in laparoscopic partial nephrectomy. Urologiia. 2014;(4);90-95. (In Russ.) eLIBRARY ID: 22370378 EDN: SVNUTN

12. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, Shamseer L, Tetzlaff JM, Akl EA, Brennan SE, Chou R, Glanville J, Grimshaw JM, Hróbjartsson A, Lalu MM, Li T, Loder EW, Mayo-Wilson E, McDonald S, McGuinness LA, Stewart LA, Thomas J, Tricco AC, Welch VA, Whiting P, Moher D. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71. https://doi.org/10.1136/bmj.n71

13. Guo Q, Lin Y, Zhang C, Guo Y, Long Y, Leng F, Gao J, Cheng Y, Yang L, Du L, Liao G, Huang. Hemostatic Agent May Improve Perioperative Outcomes in Partial Nephrectomy: A Systematic Review and Meta-Analysis. J.Urol Int. 2022;106(4):352-359. https://doi.org/10.1159/000518125

14. Aykan S, Temiz MZ, Ulus I, Yilmaz M, Gonultas S, Suzan S, Semercioz A, Muslumanoglu AY. The Use of Three Different Hemostatic Agents during Laparoscopic Partial Nephrectomy: A Comparison of Surgical and Early Renal Functional Outcomes. Eurasian J Med. 2019;51(2):160-164. https://doi.org/10.5152/eurasianjmed.2018.18293

15. Walters RC, Collins MM, L'Esperance JO. Hemostatic techniques during laparoscopic partial nephrectomy. Curr Opin Urol. 2006;16(5):327-31. https://doi.org/10.1097/01.mou.0000240303.88508.6c

16. Popkov V.M., Potapov D.Yu., Ponukalin A.N. Hemostasis methods at kidney resection. Surgery news. 2012;20(2):85-95. (InRuss.) eLIBRARY ID: 17772881 EDN: OYYALL

17. Puchkov K.V., Ivanov V.V. Tekhnologiya dozirovannogo ligiruyushchego elektrotermicheskogo vozdejstviya na etapah laparosokpicheskih operacij. Moscow: Medpraktika-M; 2005. (InRuss.)

18. Zhang F, Gao S, Zhao Y, Wu B, Chen X. Comparison of Sutureless and Conventional Laparoscopic Partial Nephrectomy: A Propensity Score-Matching Analysis. Front Oncol. 2021;11:649356. https://doi.org/10.3389/fonc.2021.649356

19. Zhang F, Gao S, Chen XN, Wu B. Clampless and sutureless laparoscopic partial nephrectomy using monopolar coagulation with or without N-butyl-2-cyanoacrylate. World J Surg Oncol. 2019;17(1):72. https://doi.org/10.1186/s12957-019-1614-8

20. Rossi P, Bove P, Montuori M, De Majo A, Ricciardi E, Mattei M, Bernardini R, Calzetta L, Mauti P, Intini L, Quattrini V, Chiaramonte C, Vespasiani G. Partial nephrectomy using radiofrequency incremental bipolar generator with multi electrode probe: experimental study in bench pig kidneys. BMC Urol. 2014;14:7. https://doi.org/10.1186/1471-2490-14-7

21. Guillonneau B, Bermúdez H, Gholami S, El Fettouh H, Gupta R, Adorno Rosa J, Baumert H, Cathelineau X, Fromont G, Vallancien G. Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol. 2003;169(2):483-6. https://doi.org/10.1097/01.ju.0000045225.64349.bf

22. Nosov A.K., Lushina P.A., Petrov S.B., Vorobiev A.V., Kalinin P.S., Mishchenko A.V. Comparison of laparoscopic resection of the kidney in renal tumors with and without the application of a hemostatic suture. Problems in oncology. 2017;63(2):281-286. (In Russ.) https://doi.org/10.37469/0507-3758-2017-63-2-281-286

23. Hongo F, Kawauchi A, Ueda T, Fujihara-Iwata A, Nakamura T, Naya Y, Kamoi K, Okihara K, Miki T. Laparoscopic off-clamp partial nephrectomy using soft coagulation. Int J Urol. 2015;22(8):731-4. https://doi.org/10.1111/iju.12808

24. Sengupta S, Webb DR. Use of a computer-controlled bipolar diathermy system in radical prostatectomies and other open urological surgery. ANZ J Surg. 2001;71(9):538-40. https://doi.org/10.1046/j.1440-1622.2001.02186.x

25. Popkov V.M., Potapov D.Yu., Ponukalin A.N., Durnov D.A. Methods of the final bleedings stoppage from kidney parenchyma. Bulletin of medical internet conferences. 2013;3(4):869-875. (InRuss.) eLIBRARY ID: 18973240 EDN: PZEZFZ

26. Malashenko A.S., Poddubnyĭ I.V., Faĭzulin A.K., Fedorova E.V., Tolstov K.N., Petrova M.G. Laparoscopic and open heminephrectomy in children: results comparison. Pirogov russian journal of surgery. 2014;(10):68-72. (In Russ.) eLIBRARY ID: 22604372 EDN: TAQYFF

27. Fujimoto K, Tanaka N, Hirao Y. [Partial nephrectomy for renal cell carcinoma using a microwave tissue coagulator--postoperative recurrence and renal function]. Hinyokika Kiyo. 2005;51(8):511-5. (In Japanese) PMID: 16164265

28. Safronova E.U., Nushko K.M., Alekseev B.Y., Kalpinskiy A.S., Polyakov V.A., Kaprin A.D. Methods of performing of hemost asis during kidney resection. Research and Practical Medicine Journal. 2016;3(1):58-65. (In Russ.) https://doi.org/10.17709/2409-2231-2016-3-1-8

29. Huang J, Zhang J, Wang Y, Kong W, Xue W, Liu D, Chen Y, Huang Y. Comparing Zero Ischemia Laparoscopic Radio Frequency Ablation Assisted Tumor Enucleation and Laparoscopic Partial Nephrectomy for Clinical T1a Renal Tumor: A Randomized Clinical Trial. J Urol. 2016;195(6):1677-83. https://doi.org/10.1016/j.juro.2015.12.115

30. Matsui Y, Fujikawa K, Iwamura H, Oka H, Fukuzawa S, Takeuchi H. Application of the microwave tissue coagulator: is it beneficial to partial nephrectomy? Urol Int. 2002;69(1):27-32. https://doi.org/10.1159/000064356

31. Satoh Y, Uozumi J, Nanri M, Nakashima K, Kanou T, Tokuda Y, Fujiyama C, Masaki Z. Renal-tissue damage induced by laparoscopic partial nephrectomy using microwave tissue coagulator. J Endourol. 2005;19(7):818-22. https://doi.org/10.1089/end.2005.19.818

32. Nanri M, Udo K, Kawasaki M, Tokuda Y, Fujiyama C, Uozumi J, Toda S. Microwave tissue coagulator induces renal apoptotic damage to preserved normal renal tissue following partial nephrectomy. Clin Exp Nephrol. 2009;13(5):424-429. https://doi.org/10.1007/s10157-009-0180-8

33. Wen CC, Nakada SY. Energy ablative techniques for treatment of small renal tumors. Curr Opin Urol. 2006;16(5):321-6. https://doi.org/10.1097/01.mou.0000240302.11379.5b

34. Berger A, Crouzet S, Canes D, Haber GP, Gill IS. Minimally invasive nephron-sparing surgery. Curr Opin Urol. 2008;18(5):462-6. https://doi.org/10.1097/MOU.0b013e32830a4f10

35. Sprunger J, Herrell SD. Partial laparoscopic nephrectomy using monopolar saline-coupled radiofrequency device: animal model and tissue effect characterization. J Endourol. 2005;19(4):513-9. https://doi.org/10.1089/end.2005.19.513

36. Tan YH, Young MD, L'Esperance JO, Preminger GM, Albala DM. Hand-assisted laparoscopic partial nephrectomy without hilar vascular clamping using a saline-cooled, high-density monopolar radiofrequency device. J Endourol. 2004;18(9):883-7. https://doi.org/10.1089/end.2004.18.883

37. Zhang C, Xu Y, Zhang Z, Qiao B, Yang K, Liu R, Ma B. Laparoscopic simple enucleation and coagulation on tumor bed using argon beam coagulator for treating small renal cell carcinomas: an animal study followed by clinical application. Med Sci Monit. 2012;18(5):BR193-7. https://doi.org/10.12659/msm.882729

38. Shanberg AM, Zagnoev M, Clougherty TP. Tension pneumothorax caused by the argon beam coagulator during laparoscopic partial nephrectomy. J Urol. 2002;168(5):2162. https://doi.org/10.1097/01.ju.0000032700.86450.a6

39. Arkhipova V, Enikeev M, Laukhtina E, Kurkov A, Andreeva V, Yaroslavsky I, Altschuler G. Ex vivo and animal study of the blue diode laser, Tm fiber laser, and their combination for laparoscopic partial nephrectomy. Lasers Surg Med. 2020;52(5):437-448. https://doi.org/10.1002/lsm.23158

40. Gofrit ON, Khalaileh A, Ponomarenko O, Abu-Gazala M, Lewinsky RM, Elazary R, Shussman N, Shalhav A, Mintz Y. Laparoscopic partial nephrectomy using a flexible CO2 laser fiber. JSLS. 2012;16(4):588-91. https://doi.org/10.4293/108680812X13462882737258

41. Moinzadeh A, Gill IS, Rubenstein M, Ukimura O, Aron M, Spaliviero M, Nahen K, Finelli A, Magi-Galluzzi C, Desai M, Kaouk J, Ulchaker JC. Potassium-titanyl-phosphate laser laparoscopic partial nephrectomy without hilar clamping in the survival calf model. J Urol. 2005;174(3):1110-4. https://doi.org/10.1097/01.ju.0000168620.36893.6c

42. Anderson JK, Baker MR, Lindberg G, Cadeddu JA. Large-volume laparoscopic partial nephrectomy using the potassium-titanyl-phosphate (KTP) laser in a survival porcine model. Eur Urol. 2007;51(3):749-54. https://doi.org/10.1016/j.eururo.2006.05.023

43. Hindley RG, Barber NJ, Walsh K, Petersen A, Poulsen J, Muir GH. Laparoscopic partial nephrectomy using the potassium titanyl phosphate laser in a porcine model. Urology. 2006;67(5):1079-83. https://doi.org/10.1016/j.urology.2005.11.006

44. Eret V, Hora M, Sykora R, Hes O, Urge T, Klecka J, Matejovic M. GreenLight (532 nm) laser partial nephrectomy followed by suturing of collecting system without renal hilar clamping in porcine model. Urology. 2009;73(5):1115-8. https://doi.org/10.1016/j.urology.2008.03.011

45. Jackman SV, Cadeddu JA, Chen RN, Micali S, Bishoff JT, Lee BR, Moore RG, Kavoussi LR. Utility of the harmonic scalpel for laparoscopic partial nephrectomy. J Endourol. 1998;12(5):441-4. https://doi.org/10.1089/end.1998.12.441

46. Hou CP, Lin YH, Hsu YC, Chen CL, Chang PL, Tsui KH. Using a Harmonic Scalpel "Drilling and Clamping" Method to Implement Zero Ischemic Robotic-assisted Partial Nephrectomy: An Observation Case Report Study. Medicine (Baltimore). 2016;95(3):e2349. https://doi.org/10.1097/MD.0000000000002349

47. Murat FJ, Lafon C, Cathignol D, Theillère Y, Gelet A, Chapelon JY, Martin X. Efficacité hémostatique d'un applicateur a ultrasons collimatés de haute intensité dans la néphrectomie partielle sous hilaire chez le porc [Haemostatic efficacy of a high intensity focused ultrasound applicator in lower pole partial nephrectomy in the pig]. Prog Urol. 2005;15(4):684-8. (In French) PMID: 16459686

48. Lafon C, Bouchoux G, Murat FJ, Birer A, Theillere Y, Chapelon JY, Cathignol D. High intensity ultrasound clamp for bloodless partial nephrectomy: In vitro and in vivo experiments. Ultrasound Med Biol. 2007;33(1):105-12. https://doi.org/10.1016/j.ultrasmedbio.2006.07.028

49. Basting RF, Djakovic N, Widmann P. Use of water jet resection in organ-sparing kidney surgery. J Endourol. 2000;14(6):501-5. https://doi.org/10.1089/end.2000.14.501

50. van Dijk JH, Pes PL. Haemostasis in laparoscopic partial nephrectomy: current status. Minim Invasive Ther Allied Technol. 2007;16(1):31-44. https://doi.org/10.1080/13645700601181372

51. Mamedkasimov N.A., Spot E.V., Alyaev Yu.G., Rapoport L.M., Sorokin N.I. Zero-ischemia nephron-sparing interventions for renal tumor. do we need 3D-modeling? Urologiia. 2019;(1):56-62. (In Russ.) https://doi.org/10.18565/urology.2019.16.56-62

52. Ogan K, Jacomides L, Saboorian H, Koeneman K, Li Y, Napper C, Hoopman J, Pearle MS, Cadeddu JA. Sutureless laparoscopic heminephrectomy using laser tissue soldering. J Endourol. 2003;17(5):295-300. https://doi.org/10.1089/089277903322145468

53. Hamasaki T, Kondo Y, Matuzawa I, Tsuboi N, Nishimura T. Laparoscopic partial nephrectomy using a microwave tissue coagulator for treating small peripheral renal tumors. J Nippon Med Sch. 2004;71(6):392-8. https://doi.org/10.1272/jnms.71.392

54. Alborov S.V. Organosohranyayushchee hirurgicheskoe lechenie bol'nyh opuholyami parenhimy edinstvenno funkcioniruyushchej pochki. Moscow, 2018. (InRuss.)

55. Volkova M.I., Skvortsov I.Ya., Klimov A.V., Chernyaev V.A., Kalinin S.A., Peters M.V., Matveev V.B. Comparative analysis of results of radical nephrectomy and partial nephrectomy for clinically localized renal cell carcinoma in patients with normal functioning contralateral kidney. Urologiia. 2014;(4):47-55. (In Russ.) eLIBRARY ID: 22370347 EDN: SVNUHP

56. Arora S, Rogers C. Partial Nephrectomy in Central Renal Tumors. J Endourol. 2018;32(S1):S63-S67. https://doi.org/10.1089/end.2018.0046