Objective: To compare the surgical feasibility, oncological and functional results between sutureless and suture techniques in retroperitoneal laparoscopic nephron-sparing surgery (LNSS). Materials and Methods: This retrospective study collected consecutive patients with a renal mass who underwent retroperitoneal LNSS in two high-volume centers. Propensity score matching (PSM) analysis was conducted to select two baseline homogeneous cohorts. Descriptive statistics was performed both before and after PSM. Moreover, univariate and multivariate logistic analyses were carried out to identify the risk factors of postoperative acute kidney injury (AKI), whereas Kaplan–Meier analysis for functional deterioration (new-onset stage 3 chronic kidney disease [CKD], estimated glomerular filtration rate [eGFR] <60 mL/min/1.73 m², or CKD upstaging after surgery) was utilized to compare the two cohorts. Results: After PSM at a ratio of 1:3, the sutureless group (n = 65) was compared with the suture group (n = 152) with no remaining statistically significant differences in baseline characteristics. With regard to patient outcomes, differences in warm ischemia time (WIT) (P < .001), estimated blood loss (P < .001), AKI (P = .002), length of hospital stay (P = .020), and eGFR at discharge (P < .001) were statistically significant. Meanwhile, the postoperative complication rates (9.2% versus 13.8%, P = .378) and positive surgical margins (0% versus 2.0%, P = .556) were not statistically different. At the last follow-up, the eGFR decline percent was the same (−1.5% versus −2.2%, P = .192). No difference was detected on Kaplan–Meier analysis for functional deterioration (log-rank test, P = .304). Conclusions: Sutureless technique in LNSS is safe and feasible, compared with the traditional suture method, with shorter WIT, lower AKI rate, and comparable long-term oncological and functional outcomes.

Introduction: To evaluate the potential predictive value of the Mayo Adhesive Probability (MAP) score combined with the RENAL score for intraoperative outcomes in retroperitoneal laparoscopic nephron-sparing surgery (NSS) in an Eastern Asian population. Methods: An initial of 388 patients undergoing retroperitoneal laparoscopic NSS were identified. MAP and RENAL scores were calculated according to CT and a logistic regression model was adopted as a combination of the RENAL score and the MAP score. Results: A total of 293 patients were included. The overall intraoperative complication rate was 7.5% (21 cases). The MAP score was found to correlate with operation time (OT; r = 0.169), estimated blood loss (EBL; r = 0.318), and intraoperative complications (r = 0.242). The RENAL score was correlated with warm is­chemia time (r = 0.503), OT (r = 0.334), intraoperative complications (r = 0.178), and EBL (r = 0.218). The MAP score and the RENAL score were reliable predictors of overall intraoperative complications, with areas under the curve (AUC) of 0.728 and 0.759, respectively. After combination of these 2 scores, the AUC of overall intra-operative complications was improved with statistical significance (AUC = 0.847, combination vs. RENAL score: p = 0.044 < 0.05; combination vs. MAP score: p = 0.005 < 0.05). Conclusion: The MAP score is an important predictor of EBL, OT, and intraoperative complications in retroperitoneal laparoscopic NSS and its combination with the RENAL score showed a superior predictive value compared to a single score in overall intraoperative complications. The MAP score might be considered in preoperative radiologic aspects as regularly as the RENAL score.

This study aimed to develop a simple nomogram based on the Mayo Adhesive Probability (MAP) score combined with the RENAL nephrometry score (RNS) to predict intraoperative complications before partial nephrectomy (PN) in Asian populations. This study retrospectively collected patients undergoing PN at three medical centers. Each component of the MAP score and the RNS (6 variables) was evaluated to assess its association with intraoperative complications by multivariable logistic regression with backward elimination. A total of 46 cases (7.2%) with intraoperative complications were identified among 637 patients. After backward elimination, three variables, including tumor diameter (4-7 cm vs. ≤4 cm: odds ratio [OR], 4.339; 95% confidence interval [CI], 1.943-9,692; ≥7 cm vs. ≤4 cm: OR, 8.434; 95% CI, 1.225-58.090), nearness to the collecting system (4-7 mm vs. ≥7 mm: OR, 2.988; 95% CI, 1.293-6.907; ≤4 mm vs. ≥7 mm: OR, 21.394; 95% CI, 6.122-74.756), and perirenal fat stranding type (type 1 vs. no stranding: OR, 3.119; 95% CI, 1.079-9.017; type 2 vs. no stranding: OR, 18.722; 95% CI, 6.757-51.868), were retained. The predictive power (measured by area under the curve [AUC]) of the nomogram was observed to be superior to the RNS or MAP score alone (RNS: 0.686, MAP score: 0.729, the nomogram: 0.837), but comparable to their combination (0.813). The simple nomogram contains fewer components than the combination of the RNS and MAP scores yet demonstrates equivalent predictive power for intraoperative complications.

Temiz MZ. Investig Clin Urol. 2021 Oct;62:e75. https://doi.org/10.4111/icu.20210277