The use of self-retaining barbed suture for inner layer renorrhaphy significantly reduces warm ischemia time in laparoscopic partial nephrectomy: Outcomes of a matched-pair analysis

Purpose: To investigate the efficacy of self-retaining barbed suture (SRBS) on reducing renorrhaphy time and warm ischemia time (WIT) during laparoscopic partial nephrectomy (LPN), in comparison with conventional polyglactin suture. Patients and Methods: Between February 2008 and June 2012, 115 patients underwent LPN for renal tumors at our institution. Among them, the patients whose inner layer renorrhaphy was performed using SRBS (group 1, n=33) or polyglactin suture (group 2, n=33) were retrospectively identified from prospectively collected institutional laparoscopic database (unmatched comparison). Furthermore, 17 patients from each group were matched at a 1:1 ratio in terms of sex, age, body mass index, preoperative aspects and dimensions used for an anatomic (PADUA) classification scoring system, and operative approach (transperitoneoscopic/retroperitoneoscopic) to eliminate the effects of these variables on WIT (matched-pair comparison). Demographic, perioperative, and pathologic parameters were evaluated between groups in both unmatched and matched-pair comparison. Results: The perioperative parameters including inner layer renorrhaphy time, WIT, estimated blood loss, operative time, length of hospital stay, and complication rate were not statistically different between the two groups in the unmatched comparison. Median PADUA score (9 vs 8, P=0.006), median preoperative (4 cm vs 3.6 cm, P=0.049), and pathologic (4.5 cm vs 3.5 cm, P=0.009) tumor size, however, were significantly higher in group 1. In the matched-pair analysis, inner layer renorrhaphy time (350 sec vs 505 sec, P=0.004) and WIT (19 min vs 28 min, P=0.037) were significantly reduced with the use of SRBS in group 1 without a difference of median PADUA score (8 vs 8, P=1), median preoperative (3.8 cm vs 4 cm, P=0.959), and pathologic (4.2 cm vs 4 cm, P=0.284) tumor size. Conclusions: The SRBS significantly reduced inner layer renorrhaphy time and WIT during LPN and may enable urologists to perform LPN in more challenging and larger tumors, in comparison with conventional polyglactin suture.