Novel original suture technique in partial nephrectomy: experimental evaluation of efficacy

Abstract

Introduction. Nephron-sparing surgery for localised renal cell carcinoma has firmly entered the guideline base of all urological associations. One important aspect of this surgery is the management of the renal wound after partial nephrectomy. The abundance of haemostasis methods is not only the result of relentless search, but also the real lack of universal and effective technologies.Objective. To evaluate the effectiveness of various suture techniques in partial nephrectomy.Materials & methods. The suture techniques were studied on laboratory mature male rats weighing 280 – 350 g with bilateral partial nephrectomy.  The groups were assessed: suture time and relative suture eruption rate as the ratio of the number of eruptions to the total number of ligatures tied, morphological appearance of the resection line on days 7 and 28.Results. In the continuous and novel suture groups, suture time and heat ischaemia time were comparable (p = 0.068). In the group of horizontal interrupted sutures, this indicator was significantly higher (p < 0.01). Optimization of the renorraphy technique using the novel original suture made it possible to reduce the incidence of eruption and hemorrhagic complications by 19.7% compared to the twist suture (p<0.05). The use of a novel experimental suture made it possible to speed up the suturing time by 38.5%, and to reduce the risks of morphologically confirmed acute renal injury by 58.0% compared with the classic suturing technique of renal parenchyma. This group showed mild inflammatory and necrotic changes along the suture line with resorption by the fourth week of follow-up.Conclusion. Thus, the novel surgical suture made it possible not only to overcome the problem of insufficient mechanical strength inherent in vertical sutures, to reduce the risk of thread eruption, tangential deformities, and ischemia, but also to provide an acceptable heat ischemia time. This contributed to minimal ischemic and inflammatory changes among the three study groups.