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Vol. 36. Issue 8.
Pages 497-502 (September 2012)
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Vol. 36. Issue 8.
Pages 497-502 (September 2012)
Skill and talent
Simplified renorrhaphy using self-retaining barbed suture during laparoscopic partial nephrectomy
Renorrafia simplificada empleando sutura barbada durante la nefrectomía parcial laparoscópica
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A. García-Segui??
Corresponding author
agarciasegui@gmail.com

Corresponding author.
, E. Bercowsky, M. Gascón-Mir
Servicio de Urología, Hospital General Mateu Orfila, Mahón, Spain
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Abstract
Introduction and objectives

Laparoscopic partial nephrectomy (LPN) is a challenging procedure that requires quick and effective intracorporeal suturing that could limit widespread adoption. Refinements of surgery have improved warm ischemia times and facilitated renal reconstruction. We present a technique that makes renorrhaphy easier using self-retaining barbed suture (SRBS) weaving two threads.

Patients and methods

Two patients with carcinoma of the kidney, 3.4 and 1.5cm, respectively, were subjected to the LPN. The SRBS is an absorbable polygluconate with small projections along its axis which are anchored in the tissue, distributing the tension of the suture line and eliminating the need for knots. Renorrhaphy was performed using the SRBS by two continuous suture lines without knots, setting the sutures with clips of Hem-o-lok® and adjusting it with the technique of “sliding clip”, without placing “bolsters” inside the renal parenchymal defect.

Results

Operative time was 156min and 163min, intraoperative bleeding was 50ml and 850ml, the warm ischemia time was 14.3min and 23min and follow-up time was 7 months and 3 months in the first and second cases, respectively. The hospital stay was 5 days and there were no postoperative complications.

Conclusions

Simplified renorrhaphy using SRBS is effective, hemostatic, facilitates the renal reconstruction, and can help reduce the warn ischemia time.

Keywords:
Laparoscopic partial nephrectomy
Renorrhaphy
Sutures
Resumen
Introducción y objetivos

La nefrectomía parcial laparoscópica (NPL) es una intervención desafiante que requiere sutura intracorpórea rápida y efectiva, lo que limita su aplicación de forma extendida. Refinamientos de la cirugía han mejorado los tiempos de isquemia y facilitado la reconstrucción renal. Se presenta una técnica que simplifica al máximo la renorrafia empleando sutura barbada de auto-retención (SBAR) entrelazando dos hilos.

Pacientes y métodos

A dos pacientes con carcinoma de riñón, de 3,4 y 1,5cm respectivamente, se les realizó la NPL. La SBAR es un poligliconato absorbible con pequeños salientes a lo largo de su eje que se anclan en los tejidos, distribuyendo la tensión de la línea de sutura y eliminando la necesidad de nudos. La renorrafia se realizó con la SBAR mediante dos líneas de sutura continuas sin nudos, fijando los hilos con clips de Hem-o-lok® y ajustándolos con la técnica del «clip deslizante», sin colocación de bolsters dentro del defecto del parénquima renal.

Resultados

El tiempo operatorio fue de 156 y 163 minutos, el sangrado intraoperatorio fue de 50 y 850ml, el tiempo de isquemia caliente fue de 14,3 y 23 minutos y el tiempo de seguimiento fue de 7 y 3 meses, en el primer y segundo caso respectivamente. La estancia hospitalaria fue de 5 días y no hubo complicaciones postoperatorias.

Conclusiones

La renorrafia simplificada empleando SBAR es efectiva, hemostática, facilita significativamente la reconstrucción renal y puede ayudar a disminuir los tiempos de isquemia.

Palabras clave:
Nefrectomía parcial laparoscópica
Renorrafia
Suturas

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