Sutureless Robotic-Assisted Partial Nephrectomy: A Propensity Score-Matched Analysis (UroCCR N.158)

Partial nephrectomy remains the standard of care for T1 renal tumors, and indications are increasingly expanding to more complex cases. Historically, renorrhaphy was considered a mandatory step to ensure hemostasis and secure the urinary collecting system. However, emerging data suggest that parenchymal compression may be deleterious, inducing local ischemia and the loss of functional nephrons. With the rise of robotic platforms, we explored a more minimalist philosophy: once definitive hemostasis is achieved, is suturing truly necessary?

Robotic assistance has revolutionized our ability to dissect tumors with millimeter precision, enabling tumor enucleation that strictly follows the peritumoral pseudocapsule plane. This technique ensures negative surgical margins while minimizing blood loss during the excision phase. By combining this precision with off-clamp or selective clamping approaches, global warm ischemia is eliminated. On a non-hemorrhagic tumor bed at the end of the procedure, omitting renorrhaphy becomes a logical evolution to avoid unnecessary iatrogenic trauma. This approach is illustrated in the following video from our center, demonstrating the technical fluidity of the procedure: https://www.youtube.com/watch?v=qrQz8LAT4rk.

Our propensity score-matched analysis of consecutive off-clamp Robot-Assisted Partial Nephrectomy (RAPN) procedures confirms the clinical relevance of this strategy. The primary endpoint demonstrated a clear superiority of the sutureless approach, with a Trifecta achievement rate (defined as negative surgical margins, absence of major complications, and preservation of ≥90% of preoperative eGFR) of 66.1% compared to 43.3% for standard renorrhaphy. This success was primarily driven by superior early renal function preservation. Beyond these outcomes, the technique was associated with a significant reduction in operative time, confirming that controlled technical simplification can enhance overall surgical efficiency.

These results demonstrate that in selected patients, omitting renorrhaphy is a safe, efficient, and reproducible approach that optimizes immediate functional recovery without compromising perioperative or oncological safety. The "sutureless" technique is more than just a technical alternative; it is the culmination of precision surgery dedicated to preserving every functional nephron.

Written by: Alexandre Blanco,¹ Gaëlle Margue,^1,2,3 Mokrane Yacoub,⁴ Clément Klein,¹ Vincent Estrade,¹ Éric Alezra,¹ Grégoire Capon,¹ Franck Bladou,¹ Grégoire Robert,¹ Jean-Christophe Bernhard,^1,2,3

Department of Urology and Kidney Transplantation, CHU de Bordeaux, Bordeaux, France
I.CaRe Bordeaux - BRIC INSERM U1312, Bordeaux, France.
French AFU Cancer Committee Guidelines, Paris, France.
Department of Pathology, CHU de Bordeaux, Bordeaux, France.

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