%0 Journal Article
%T The evolution of tumor enucleation partial nephrectomy: A comparison of perioperative outcomes for sutureless hemostatic bandage as an alternative to standard renorrhaphy.
%A Rac G
%A Ellis JL
%A Lanzotti NJ
%A McCormick ME
%A Felice MD
%A Janakiraman S
%A Desai S
%A Halgrimson W
%A Patel HD
%A Gupta GN
%J J Surg Oncol
%V 0
%N 0
%D 2024 Jul 11
%M 38992990
%F 2.885
%R 10.1002/jso.27775
%X <B>BACKGROUND: </B>The standard approach to hemostasis during partial nephrectomy (PN) is to perform suture renorrhaphy (SR). Application of a hemostatic bandage (HB) is an alternative to minimize blood loss and devitalized renal parenchyma. We aim to evaluate perioperative outcomes of PN with tumor enucleation (TE) comparing SR to HB.<BR><B>METHODS: </B>We analyzed a retrospective cohort of 195 patients undergoing robot-assisted laparoscopic PN with TE performed at a tertiary referral center (2012-2022). Hemostasis was obtained with SR in 54 patients while 141 patients underwent application of HB consisting of Surgicel®, Gelfoam® soaked in thrombin, and Floseal®.<BR><B>RESULTS: </B>SR patients had tumors of greater complexity by RENAL nephrometry score compared to HB patients (p < 0.001). Operative time (141 vs. 183 min, p < 0.001), warm ischemia time (11.6 vs. 24.2 min, p < 0.001), estimated blood loss (37 vs. 214 mL, p < 0.001), and length of stay (1.2 vs. 1.8 days, p < 0.001) favored HB. There was no significant difference in Clavien-Dindo grade ≥3 complications (p = 0.22). Renal function was comparable with mean estimated glomerular filtration rate decrease of 0.66 and 0.54 mL/min/1.73 m2 at 3 months postoperatively for HB and SR, respectively (p = 0.93).<BR><B>CONCLUSIONS: </B>Application of an HB is a safe alternative to SR for hemostasis following PN with TE in appropriately selected patients.