Barbed Suture for Renorrhaphy During Robot-Assisted Partial Nephrectomy
Barbed Suture for Renorrhaphy During Robot-Assisted Partial Nephrectomy
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DOI：
10.1089/end.2010.0455
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发表时间：
2011-03-01
影响因子：
2.7
通讯作者：
Rogers, Craig
中科院分区：
文献类型：
--
作者：
Sammon, Jesse;Petros, Firas;Rogers, Craig
背景和目的：机器人辅助肾部分切除术（RAPN）是一种新兴的微创肾单位保留手术技术，可能有助于解决缝合肾修补术的技术挑战。有刺缝合可实现无结伤口闭合并提高缝合效率。我们提出了第一个在人类患者 RAPN 期间进行肾修补术的倒刺缝合的临床研究，并将围手术期结果与采用聚乳酸缝合的 RAPN 进行比较。 患者和方法： 30 名连续患者由一位外科医生接受了 RAPN； 15 例使用聚乳酸缝合线进行肾修补，随后 15 例使用 V-Loc 180 (TM) 伤口闭合装置。肾修补术分两层进行，使用滑动 Hem-o-lok 夹技术连续闭合深部血管和集合系统，然后连续闭合肾包膜。比较各组的手术特点和并发症。结果：连续30例RAPN手术均成功完成肾修补术。 V-Loc 组和传统组在人口统计学和肿瘤特征方面相当。平均手术时间和控制台时间相当； V-Loc 组的热缺血时间显着缩短（18.5 分钟 vs 24.7 分钟，P = 0.008）。有刺缝合线组没有出现缝合线滑脱或撕裂的情况。倒刺使滑动夹肾修补术保持完整，无需多余的夹子来防止向后滑动。结论：使用有倒刺的缝合线简化了 RAPN 期间的肾修补术并提高了效率，从而减少了热缺血时间。我们在接受微创肾部分切除术的人类患者中证明了这种缝合技术的可行性和安全性。
Background and Purpose: Robot-assisted partial nephrectomy (RAPN) is an emerging technique for minimally invasive nephron-sparing surgery that may facilitate the technical challenges of sutured renorrhaphy. Barbed suture allows for knotless wound closure and improves suturing efficiency. We present the first clinical study of barbed suture for renorrhaphy during RAPN in human patients and compare perioperative outcomes to RAPN with polyglactin suture.Patients and Methods: Thirty consecutive patients underwent RAPN by a single surgeon; 15 using polyglactin suture for renorrhaphy followed by 15 using the V-Loc 180 (TM) wound closure device. Renorrhaphy was performed in two layers, with a continuous running closure of deep vessels and the collecting system, followed by a running closure of the renal capsule, using the sliding Hem-o-lok clip technique. Operative characteristics and complications were compared between groups.Results: Renorrhaphy was successfully completed in all 30 consecutive RAPN procedures. V-Loc and conventional groups were equivalent in demographic and tumor characteristics. Mean operative and console time were equivalent; warm ischemia time was significantly shorter in the V-Loc group (18.5 vs 24.7 min, P = 0.008). There were no instances of suture slippage or tearing in the barbed suture group. The barbs held the sliding clip renorrhaphy intact without the need for redundant clips to prevent backsliding.Conclusion: Use of barbed suture simplifies the renorrhaphy technique during RAPN and improves efficiency, allowing for reduced warm ischemia times. We demonstrate feasibility and safety of this suture technique in human patients undergoing minimally invasive partial nephrectomy.