A Modified “Cross-Stitch” Suturing Technique Is Associated with Shorter Warm Ischemia Time in Robot-Assisted Partial Nephrectomy

Abstract

Objectives:

To compare the efficacy of traditional double-layer suturing techniques vs an improved “cross-stitch” suturing technique (CST) in robot-assisted partial nephrectomy (RAPN) for localized renal cell carcinoma.

Patients and Methods:

We retrospectively analyzed clinical data from patients who underwent RAPN at our center between August 2022 and January 2025. A total of 89 patients were ultimately included, including 58 in the double-layer suture group and 31 in the “cross-stitch” suturing technique group. To minimize selection bias, 1:1 propensity score matching (PSM) was performed to balance baseline characteristics between groups (matched covariates: age, body mass index, RENAL score, tumor size, tumor location, and growth pattern). In the matched cohort, a double robust estimation strategy was applied. Multivariate regression models were used to adjust for residual confounders, enabling comparison of perioperative indicators, early renal function changes, and postoperative complications between the two groups.

Results:

After PSM, 52 patients (26 in each group) were analyzed, and the clinical baseline characteristics of both patient groups achieved favorable matching, with significantly reduced differences in the distribution of covariates such as age, BMI, tumor size, radius, exophytic/endophytic, nearness to collecting system, anterior/posterior, location score, tumor location, and growth pattern (standardized mean difference <0.1). Compared with the double-layer suturing group, the “cross-stitch” suturing technique group had a significantly shorter operative time (111.1 vs 133.4 minutes, p = 0.002) and warm ischemia time (WIT) (15.4 vs 20.5 minutes, p < 0.001). However, no statistically significant differences were observed between groups in estimated blood loss (p = 0.362), postoperative hospital stay (p = 0.349), positive margin rate (p = 0.932), postoperative complications (p = 0.315), or trifecta achievement rate (p = 0.07).

Conclusion:

The modified CST was associated with shorter WIT and operative time and may be particularly suitable for localized renal tumors of moderate complexity. However, no significant differences were observed in postoperative renal function or trifecta after matching, and these findings should be interpreted with caution and require further validation.