The quantity of the preserved parenchyma after partial nephrectomy is the result of interplay among various factors: the unmodifiable preoperative quality of the renal parenchyma and some technical modifiable aspects. Among the modifiable factors able to influence the quantity, the suture technique has gained paramount importance. Indeed, nowadays there is a consensus suggesting that one of the main predictors of the ultimate renal function is the minimal parenchymal volume loss: this is the sum of the healthy parenchyma excised with the tumour and the portion of the parenchyma devascularised by the renorrhaphy. The historical aim of a good suture was to avoid bleeding and urine leakage. A modern suture after partial nephrectomy should minimise the ischaemic effect on the renal parenchyma whenever possible. This has to be carried out with precision and based on the vascular anatomy of the kidney.
In this report, we tried to describe the best practice for the suturing of renal parenchyma after conservative surgical treatment for small renal tumours. Indeed, the suture after the resection of a renal mass should minimise the ischaemic effect on the renal tissue whenever possible, maximising the functional outcomes.
European urology focus. 2017 Aug 28 [Epub ahead of print]
Francesco Porpiglia, Riccardo Bertolo, Daniele Amparore, Cristian Fiori
Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy. Electronic address: ., Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, School of Medicine, Orbassano, Turin, Italy.