Laparoscopic suture-free partial nephrectomy using argon-beam-coagulator: Surgical technique and outcomes of a single-center, open-label randomized controlled trial

Wenfeng Li; Jiangyi Wang; Guopeng Yu; Bao Hua; Xin Gu; Shangqing Song; Chao Lu; Lin Zhou; Long Li; Yushan Liu; Qing Yang; Bin Xu

doi:10.1016/j.urolonc.2024.11.006

Laparoscopic suture-free partial nephrectomy using argon-beam-coagulator: Surgical technique and outcomes of a single-center, open-label randomized controlled trial

Urol Oncol. 2024 Nov 21:S1078-1439(24)00720-8. doi: 10.1016/j.urolonc.2024.11.006. Online ahead of print.

Authors

Wenfeng Li¹, Jiangyi Wang¹, Guopeng Yu¹, Bao Hua¹, Xin Gu¹, Shangqing Song¹, Chao Lu¹, Lin Zhou¹, Long Li¹, Yushan Liu¹, Qing Yang¹, Bin Xu²

Affiliations

¹ Department of Urology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China.
² Department of Urology, Shanghai Ninth People's Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China. Electronic address: chxb2004@shsmu.edu.cn.

PMID: 39578201
DOI: 10.1016/j.urolonc.2024.11.006

Abstract

Objective: To determine whether argon-beam-coagulation (ABC) suture-free technique results in more favorable renal function than conventional suture technique after laparoscopic partial nephrectomy.

Methods: This study was a single-center, open-label randomized controlled study. A total of 32 patients with T1a renal tumor and R.E.N.A.L score ≤7 were recruited. The primary endpoint of the study was the absolute variation of the ipsilateral split renal function (SRF) at 12 months. The following secondary endpoints were addressed: the 1, 3, 6, and 12-months variation of eGFR; the 1, 3, 6-months variation of SRF; perioperative outcomes (including operative time, warm ischemia time, time to hemostasis, blood loss).

Results: The suture-free group had a significantly shorter operative time (90.4 ± 22.0 minutes vs. 117.8 ± 23.5 minutes, p = 0.003) and warm ischemia time (9.6 ± 4.7 minutes vs. 21.3 ± 8.3 minutes, p < 0.001) than the suture group. At the last follow-up, the change of ipsilateral SRF was 7.5 ± 5.1 ml/min for the suture-free group and 13.1 ± 6.7 ml/min for the suture group (p = 0.014). The change of eGFR demonstrated a similar trend (5.5 ± 4.4 ml/min vs. 12.6 ± 6.0 ml/min, p=0.001). Multivariate linear analysis confirmed that suture-free technique was associated with a less decrease of renal function.

Conclusions: Suture-free partial nephrectomy is a feasible technique for T1a renal masses and benefits long-term SRF and eGFR compared to conventional procedure.

Keywords: Argon-beam-coagulator; Glomerular filtration rate; Partial nephrectomy; Suture-free.