Department of Urology, University of Texas Southwestern Medical Center, Dallas, TX, USA.
BJU Int. 2012 Mar;109(6):906-9. doi: 10.1111/j.1464-410X.2011.10547.x. Epub 2011 Oct 12.
To evaluate the efficacy of a self-retaining barbed suture (SRBS) in achieving a secure and haemostatic renorrhaphy during laparoscopic partial nephrectomy (LPN). To compare perioperative outcomes for LPN with SRBS with those for LPN with conventional polyglactin suture, with specific attention to warm ischaemia time, blood loss and need for postoperative bleeding interventions.
Patients who underwent LPN between June 2007 and October 2010 were identified through an Institutional Review Board approved registry of oncological patients. Before July 2009, parenchymal repair after tumour excision was performed using absorbable polyglactin suture (Group 1), and subsequently, using SRBS (Group 2). Demographic, clinical, intraoperative and postoperative outcomes were compared for each group.
LPN was performed in 49 patients in Group 1 and 29 in Group 2. Baseline demographic and clinical features, estimated blood loss, and transfusion and embolization rates were statistically similar for the cohorts. Mean warm ischaemia time (±SD) was significantly shorter for the SRBS group (26.4 ± 8.3 vs 32.8 ± 7.9; P= 0.0013). Bleeding requiring intervention (open conversion or transfusion ± embolization) was more common for Group 1 (9/49, 18.4% vs 1/29, 3.4%; P= 0.06).
The use of SRBS for parenchymal repair during LPN in humans is safe and is associated with a significant reduction in warm ischaemia time. SRBS use during LPN may also reduce rates of clinically significant bleeding. Prospective, larger studies to confirm the value of SRBS use in minimally invasive partial nephrectomy are warranted.
评估自固定倒刺缝线（SRBS）在腹腔镜部分肾切除术（LPN）中实现安全止血肾缝合的效果。比较使用 SRBS 与传统聚甘醇酸缝线进行 LPN 的围手术期结果，特别关注热缺血时间、出血量和术后出血干预的需求。
通过机构审查委员会批准的肿瘤患者登记处，确定了 2007 年 6 月至 2010 年 10 月期间接受 LPN 的患者。在 2009 年 7 月之前，肿瘤切除后的实质修复使用可吸收聚甘醇酸缝线（第 1 组），随后使用 SRBS（第 2 组）。比较每组的人口统计学、临床、术中及术后结果。
第 1 组中有 49 例患者接受了 LPN，第 2 组中有 29 例患者接受了 LPN。两组的基线人口统计学和临床特征、估计出血量以及输血和栓塞率在统计学上相似。SRBS 组的平均热缺血时间（±SD）明显更短（26.4±8.3 比 32.8±7.9；P=0.0013）。需要干预的出血（开放性转化或输血±栓塞）在第 1 组更常见（9/49，18.4%比 1/29，3.4%；P=0.06）。
在人类的 LPN 中使用 SRBS 进行实质修复是安全的，并且与热缺血时间的显著减少相关。LPN 中使用 SRBS 还可能降低临床上显著出血的发生率。需要进行前瞻性、更大规模的研究来证实 SRBS 在微创部分肾切除术应用中的价值。
