Reconstruction Techniques After Partial Nephrectomy: Classic vs. Sutureless Approach—A Narrative Review

• Published in: Current urology reports Vol. 25; no. 2; pp. 49 - 54
• Main Authors: Moreno Cortés, J. C., González García, J., Caño Velasco, J., Aragón Chamizo, J., Subirá Rios, D.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01-02-2024
• Subjects: Medicine; Medicine & Public Health; Nephrology; Topical Collection on Kidney Diseases; Urology; Robotic-assisted procedure; Partial nephrectomy; Laparoscopy; Surgical reconstruction; Hemostasis; Renorrhaphy
• ISSN: 1527-2737; 1534-6285
• DOI: 10.1007/s11934-023-01194-1

Purpose of Review
The purpose of this review is to update the information about the different types of reconstruction after partial nephrectomy, with special emphasis on the new methods of suture-free hemostasis currently available.
Recent Findings
The aim of renal reconstruction is to avoid bleeding and leakage of the collecting system, but now the renorrhaphy technique used is considered one of the modifiable determinants of renal function after surgery. In an attempt to avoid the loss of renal function implicit in classic reconstruction, new techniques have been described to control hemostasis and urinary leakage, which employ fewer suture layers, different suture materials and designs, and a wide range of commercially available hemostatic materials.
Summary
Multiple suture characteristics have been studied as a potential factor influencing the renal function observed after partial nephrectomy. Single-plane suture techniques, the use of bearded sutures, and running sutures seem to be associated with less deterioration in postoperative renal function, and deep medullary sutures should be avoided to avoid affecting the arcuate arteries. Sutureless hemostasis systems could prevent the deterioration of renal function and complications derived from suturing, also reducing ischemia time and surgical time without increasing the risk of complications.