Simplified laparoscopic partial nephrectomy using a single-layer closure and no bolsters for renal tumors

Abstract

Objectives: Surgical outcomes for a simplified LPN technique using a single-layer closure were reviewed for central and peripheral renal tumors.

Methods: A total of 159 consecutive patients who underwent LPN were identified using a single-institution database. Renal tumors abutting the collecting system or renal sinus were considered central. After tumor excision, the tumor bed was repaired using a single layer closure by passing partially straightened CPX needles beneath the entire cut surface. Pathologic and postoperative outcomes were compared between the central tumor group (CTG) and the peripheral tumor group (PTG).

Results: There were 83 and 76 patients in the CTG and PTG, respectively. When compared with the PTG, the CTG had a larger mean tumor size (3.4 vs 2.3 cm, P <.0001) and greater depth of tumor invasion (2.3 vs 1.1 cm, P <.0001). In the CTG, 66 tumors were malignant, and 2 patients had a positive margin. In the PTG, 50 tumors were malignant, and 1 patient had a positive margin. There was no statistically significant difference between the groups in operative times, estimated blood loss, transfusion rates, complications, positive margins, and length of hospital stays. The CTG had a longer warm ischemia time (24 vs 18 minutes, P = .0002), but this did not result in a significant difference in postoperative creatinine clearance (86 vs 87, P = .842).

Conclusions: During LPN, a single-layer closure without bolsters is safe and effective, and early surgical outcomes are similar for central and peripheral tumors.