Can a single-layer of renorrhaphy be applied with hemostatic agent in robotassisted laparoscopic nephron-sparing surgery applied to complex renal tumors?

Objective: To compare outcomes of single- layer renorrhaphy suturing and hemostatic agent application with double-layer renorrhaphy among complex renal tumors. Material and Methods: 51 patients who underwent robotic partial nephrectomy due to complex renal tumors (PADUA score ≥10) between August 2017 and February 2021 were retrospectively enrolled. A double-layer renorrhaphy was applied in 36 patients (Group 1), and a single-layer renorrhaphy plus hemostatic agent FloSeal® (Baxter Medical, Fremont, CA) was applied in 15 patients (Group 2). Pre- and post-operative serum creatinine, glomerular filtration rate, hemoglobin levels, surgical and warm ischemia time, drainage, hospital stay duration, as well as complications were all evaluated. Results: Group 1 and Group 2 mean PADUA scores were 11 and 10.47, respectively. The mean preoperative, postoperative 1st day and 6th month serum creatinine were 1.02, 1.15 and 1.09 mg/dL in the Group 1 and were 0.93, 1.02 and 0.90 mg/dL in the Group 2, respectively. The mean preoperative, postoperative 1st day and 6th month glomerular filtration rates were 91.47, 77.31 and 81.90 mL/ min/1.73m2 in the Group 1 and were 92.07, 84.93 ve 90.73 mL/min/1.73m2 in the Group 2, respectively. Operation and warm ischemia time were 118min and 23min in the Group 1, and 101min and 13 min in the Group 2, respectively. There was no significant difference between groups in terms of drain removal time and hospital stay. Perioperative only Clavien I and II complications were observed with no recurrence during the follow-up. Conclusion: A single-layer of renorrhaphy plus hemostatic agent application can be safely applied in complex renal tumors with a PADUA score between 10-11 undergoing robotic partial nephrectomy. Keywords: robotic partial nephrectomy, nephron sparing surgery, renorrhaphy, complex renal tumor