Barbed Suture for Renorrhaphy During Robot-Assisted Partial Nephrectomy

Abstract

Objectives:

Robot-assisted partial nephrectomy (RAPN) is an emerging technique for minimally invasive nephron sparing surgery with potential to facilitate the technical challenges of sutured renorrhaphy under warm ischemia. Barbed suture is a product introduced for knotless wound closure to improve suturing efficiency. We have incorporated barbed suture into our renorrhaphy technique for RAPN. We present the first examples of barbed suture for use in the renorrhaphy of human patients undergoing RAPN.

Methods:

The Quill^TM SRS #0, on a CT-1, and the V-Loc^TM180 3-0, on an SH needle, were used in our RAPN procedures. In this video we demonstrate four applications of barbed suture for closure of the deep and capsular layers of renorrhaphy. The Quill and a constructed double-armed V-loc suture were each used to close both the resection bed followed by the renal capsule using a single suture. The Quill was used for horizontal mattress closure of the capsule during an “off-clamp” RAPN and the V-Loc was used to close the deep layer and perform figure-of-eight vessel ligation in the setting of early unclamping.

Summary of Results:

Renorrhaphy was completed in six RAPNs using barbed suture with a mean warm ischemia time of 13.8 min and with no urine leaks, hemorrhage, or other complications. The sliding hem-o-lok clip technique was used without the need for redundant clips to prevent slippage.

Conclusions:

Use of barbed suture for the renorrhaphy of RAPN simplifies the technique and improves efficiency, potentially allowing for reduced warm ischemia times and tighter renal closures.

No competing financial interests exist.

Runtime of video: 6 mins 56 secs