Tatenuma Tomoyuki, Takiyama Hikaru, Yamada Takahiro, Kobayashi Kota, Jikuya Ryosuke, Noguchi Go, Ito Hiroki, Mitsuru Komeya, Ito Yusuke, Muraoka Kentaro, Hasumi Hisashi, Makiyama Kazuhide
Department of Urology, Yokohama City University Hospital, 3-9 Fukuura, Kanazawaku, Yokohama, Kanagawa, 2360-004, Japan.
Graduate School of Environment and Information Sciences, Yokohama National University, Yokohama, Kanagawa, Japan.
J Robot Surg. 2025 Jul 18;19(1):402. doi: 10.1007/s11701-025-02580-2.
The objective of this study is to evaluate mechanical tension on the renal parenchyma during partial nephrectomy using a novel index and compare the effects of different suture techniques on strain in a simulated model. A kidney-shaped urethane resin model with surface markers was created to measure deformation. Three-dimensional scanning assessed deformation before and after suturing. Strain values were calculated using finite-element shape functions on a triangular mesh. Distance from the centerline of the suture was also measured. The standard suturing method was defined as continuous stitches using self-retaining barbed sutures. Based on this standard, variations were introduced in suture material, suturing technique (continuous or interrupted), number of stitches, and the distance from the defect edge. Seven suture patterns were tested. Deformation values were higher when sutures were placed farther from the defect margin and lower when placed closer. Interrupted, tight, sparse, and multifilament suture patterns produced strain values similar to those of the standard technique. Narrow suture pattern tended to have longer distances from the centerline than the wide suture pattern. Interrupted and multifilament suture patterns also showed slightly longer distances than the standard pattern. This is the first study to visualize and quantify strain distribution during renorrhaphy using deformation values. The findings suggest that the distance of suture placement from the limbus may impact parenchymal strain. Despite limitations such as a small sample size and use of simulated models, these results offer insights into optimizing renorrhaphy techniques to minimize tissue stress. Future studies with larger sample sizes are warranted.
本研究的目的是使用一种新的指标评估部分肾切除术期间肾实质的机械张力，并在模拟模型中比较不同缝合技术对应变的影响。创建了一个带有表面标记的肾形聚氨酯树脂模型来测量变形。三维扫描评估缝合前后的变形情况。使用三角形网格上的有限元形状函数计算应变值。还测量了距缝合线中心线的距离。标准缝合方法定义为使用自固定倒刺缝线进行连续缝合。基于此标准，在缝合材料、缝合技术（连续或间断）、缝线数量以及距缺损边缘的距离方面引入了变化。测试了七种缝合方式。缝线放置离缺损边缘越远，变形值越高；放置越近，变形值越低。间断、紧密、稀疏和多丝缝合方式产生的应变值与标准技术相似。窄缝合方式的中心线距离往往比宽缝合方式更长。间断和多丝缝合方式的中心线距离也比标准方式略长。这是第一项使用变形值可视化和量化肾缝合术期间应变分布的研究。研究结果表明，缝线放置距边缘的距离可能会影响实质应变。尽管存在样本量小和使用模拟模型等局限性，但这些结果为优化肾缝合技术以最小化组织应力提供了见解。有必要进行更大样本量的未来研究。
