Di Franco Gregorio, Furbetta Niccolò, Guadagni Simone, Comandatore Annalisa, Mastrangelo Mattia, Caprili Giovanni, Ramacciotti Niccolò, Bechini Bianca, Ujka Ornela, Gaeta Raffaele, Pollina Luca, Palmeri Matteo, Morelli Luca
General Surgery Unit, Department of Translational Research and New Technologies in Medicine and Surgery, University of Pisa, Pisa, Italy.
Multidisciplinary Center of Robotic Surgery, University Hospital of Pisa, Pisa, Italy.
Ann Surg Oncol. 2025 Aug 19. doi: 10.1245/s10434-025-18090-2.
Effective hemostasis and renorrhaphy with intracorporeal suturing are major technical challenges in robot-assisted partial nephrectomy (RAPN). This report outlines the authors' experience with a novel RAPN approach using renorrhaphy with barbed sutures (BSs) and elongated pledgets (R-BEP) in a video.
The R-BEP procedure comprised several steps, including a single layer of monofilament adsorbable running BSs used to close the renal parenchyma, reinforced by elongated polytetrafluoroethylene (PTFE) pledgets. Two PTFE pledgets, approximately 8 to 10 mm in width, were cut to match the resection bed. Suturing began at one end of the resection bed, with bites placed 3 to 5 mm apart. The BSs maintained tension throughout the single-suture bites.
The RAPN procedure with R-BEP was performed for 55 patients, including 38 (69.1%) patients with a RENAL score of 7 or higher. The mean operation time was 183.3 ± 51.3 min, and the mean warm ischemia time was 22.5 ± 9.6 min. Complete hemostasis and urostasis were achieved for all the patients without the need for additional clamping or procedures for renorrhaphy. No patient was converted to laparoscopic or open surgery or experienced major intraoperative bleeding. Postoperatively, one patient experienced urinary leakage, which was successfully managed with a ureteral stent. No postoperative bleeding, reoperation, or mortality were reported.
The R-BEP procedure was safe and effective for the treatment of complex renal tumors with a high RENAL score using minimally invasive RAPN, improving the workflow and delivering satisfactory outcomes.
在机器人辅助部分肾切除术（RAPN）中，有效的止血和体内缝合肾修补术是主要的技术挑战。本报告概述了作者在视频中使用带倒刺缝线（BSs）和延长垫片（R-BEP）进行肾修补术的新型RAPN方法的经验。
R-BEP手术包括几个步骤，包括使用单层单丝可吸收连续BSs闭合肾实质，并用延长的聚四氟乙烯（PTFE）垫片加强。将两个宽度约为8至10毫米的PTFE垫片切割成与切除床相匹配的尺寸。缝合从切除床的一端开始，针距为3至5毫米。BSs在整个单针缝合过程中保持张力。
对55例患者进行了R-BEP的RAPN手术，其中38例（69.1%）患者的RENAL评分为7分或更高。平均手术时间为183.3±51.3分钟，平均热缺血时间为22.5±9.6分钟。所有患者均实现了完全止血和尿路梗阻，无需额外夹闭或进行肾修补手术。没有患者转为腹腔镜或开放手术，也没有发生术中大出血。术后，1例患者出现尿漏，通过输尿管支架成功处理。未报告术后出血、再次手术或死亡情况。
R-BEP手术对于使用微创RAPN治疗RENAL评分高的复杂肾肿瘤是安全有效的，改善了工作流程并取得了满意的结果。
