A Novel Partial Nephrectomy Technique Using Blunt Dissection, Clipping of Intrarenal Vessels, Followed by Closure Using a Fibrin Sealant and Sliding Clips

Abstract

We describe a surgical technique for robotic-assisted partial nephrectomy, including 3 novel steps to facilitate resection and suturing. This approach minimizes positive surgical margins and the risk of postoperative bleeding. This article describes a retrospective study of a single-surgeon series, including 49 patients. The study approach includes descriptive analysis of the Intraoperative Adverse Incident Classification, analysis of postoperative complications using the Clavien-Dindo Classification, and description of pathological and oncological outcomes. The median operative time was 221 minutes (IQR: 196-263), and the median ischemia time was 20 minutes (IQR: 12-24). Intraoperative Adverse Incident Classification Grade 1 complications occurred in 2 patients (4%). Conversion to open partial nephrectomy was necessary in 1 patient (2%). Postoperative complications were reported in 7 patients (14%). Of these, 3 patients (6%) experienced a Clavien-Dindo Classification Grade 2 complication, 2 patients (4%) experienced a Grade 3a complication, 1 patient (2%) experienced a Grade 3b complication, and 1 patient (2%) experienced a Grade 4a complication. Endovascular coiling and blood transfusion were necessary in 2 patients (4%), and 2 patients (4%) were readmitted. A positive surgical margin was reported in 1 patient (2%). Metastatic relapse occurred in 1 patient (2%) 535 days after surgery who did not have a positive surgical margin. Our novel 3 surgical steps during robotic-assisted partial nephrectomy allow an oncologically safe resection with a low risk of postoperative complications.