Comparison of robot-assisted partial nephrectomy with soft coagulation and double-layer technique for complex and non-complex tumors

Objectives: To compare the postoperative outcomes of robot-assisted partial nephrectomy when only the inner layer is sutured (single-layer technique with soft coagulation) with those when sutures are placed in the inner and outer layers (double-layer technique) in patients with and without complex renal tumors.
Methods: This retrospective three-institution study included 371 patients with renal tumors who underwent robot-assisted partial nephrectomy with a double-layer technique or a single-layer technique with soft coagulation. Tumors that were cT1b, completely embedded, located in the renal portal, or had a RENAL score of ≥10 were considered complex. Relevant data were collected from hospital records. Propensity score matching was performed to minimize selection bias.
Results: Propensity score matching created 83 patient pairs with non-complex tumors and 32 with complex tumors. Regardless of tumor complexity, there was no significant difference in operation time, console time, warm ischemia time, positive surgical margin rate, or length of hospital stay between the double-layer and single-layer groups. Although Clavien–Dindo grade I–II urinomas not requiring intervention were significantly more common in the single-layer group regardless of tumor complexity, there was no significant between-group difference in the rate of decline in renal function or grade III–IV complications.
Conclusion: Single-layer suturing with soft coagulation achieves renal function and perioperative outcomes comparable to those of double-layer suturing regardless of complexity.

内容要旨・審査要旨・論文本文の公開
本論文は，著者Keito Shiozakiの学位論文として提出され，学位審査・授与の対象となっている。

This is the peer reviewed version of the following article: Shiozaki, K., Izumi, K., Sasaki, Y., Kusuhara, Y., Fukawa, T., Yamamoto, Y., Yamaguchi, K., Izaki, H., Takahashi, M., Kawanishi, Y., Kanayama, H. (2022). Comparison of robot-assisted partial nephrectomy with soft coagulation and double-layer technique for complex and non-complex tumors. International Journal of Urology, 30, 3, 281-288., which has been published in final form at https://doi.org/10.1111/iju.15112. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions. This article may not be enhanced, enriched or otherwise transformed into a derivative work, without express permission from Wiley or by statutory rights under applicable legislation. Copyright notices must not be removed, obscured or modified. The article must be linked to Wiley’s version of record on Wiley Online Library and any embedding, framing or otherwise making available the article or pages thereof by third parties from platforms, services and websites other than Wiley Online Library must be prohibited.