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Page 6 of 10 De Nunzio et al. Mini-invasive Surg 2024;8:22 https://dx.doi.org/10.20517/2574-1225.2023.138

Comparison between interrupted and running renorrhaphy
[21]
A recently published systematic review states that when it comes to minimally invasive partial
nephrectomy, using an interrupted renorrhaphy technique led to increased operative time, ischemia time,
[35]
and complications compared to the running suture technique. In another systematic review on this topic,
the same author underlined how these two different techniques affect renal function. There are no
significant differences between pre- and postoperative estimated glomerular filtration rate (eGFR) in both
patients who received an interrupted suture (WMD -4.88 mL/min, 95% confidence interval [CI] -11.38;
1.63, P = 0.14) or those who received a running suture (-3.42 mL/min, 95%CI -9.96; 3.12, P = 0.31). Despite
the interrupted suture technique resulting in longer ischemia times, it does not produce a difference in renal
functional outcome, affirming the existing literature’s indication of a minimal effect on renal function due
to prolonged ischemic periods.

Presenting similar baseline features, the analysis compared single- vs. double-layer renorrhaphy about pre-
and postoperative GFR data (321 vs. 199 patients) and it showed a better functional outcome for the single-
layer technique (-3.19 mL/min, 95%CI -8.09; 1.70, P = 0.2 vs. -6.07 mL/min, 95%CI -10.75; -1.39, P = 0.01).

In another study that compared 118 patients who underwent renorrhaphy with 38 patients who did not, the
results demonstrated significant differences. The nonrenorrhaphy group exhibited a 3.8% volume loss
compared to a 15.6% volume loss in the renorrhaphy group (P < 0.001). Moreover, a 2.4% GFR loss in the
nonrenorrhaphy group versus an 8.9% GFR loss in the renorrhaphy group (P = 0.03). Volume changes were
assessed using preoperative and postoperative CT scans, and multivariable analysis indicated that
renorrhaphy was a predictor of renal volume loss (P < 0.01). Significantly, the two groups had no substantial
differences in complications such as bleeding and urinary leaks. It is important to acknowledge a limitation
of this study. All patients in the nonrenorrhaphy group were treated using an open approach, while the
renorrhaphy group included both open and robotic approaches .
[36]

Comparison between single-layer and double-layer renorraphy
Porpiglia et al. conducted a study comparing patients who underwent a sliding loop single-layer
renorrhaphy to the ones who received a double-layer closure .
[37]

They did not observe any significant disparities in serum creatinine levels and eGFR. Nevertheless, there
was a discernible difference when assessing the renal function of the ipsilateral kidney at the three-month
postoperative milestone. The group with double-layer closure exhibited a 16.3% decline, whereas the single-
layer closure group displayed only a 7.3% decrease (P < 0.05) [36,38] [Table 1].

Comparison between barbed and no barbed renorrhaphy
Various studies have examined the comparison between barbed and non-barbed sutures. These studies
ensured that the groups under investigation were well-matched considering age, body mass index (BMI),
and tumor size. A favorable performance was observed in favor of running sutures, with notable reductions
in operating time [mean difference of 8.80 min (95%CI 12.97, 4.64)], WIT [6.70 min (95%CI 7.82, 5.57)],
and blood loss [46.31 mL (95%CI 55.23, 37.39)]. However, no discernible differences were detected
regarding postoperative complications, transfusions, or urinary leakages .
[21]

RENORRHAPHY AND URINARY COLLECTING SYSTEM REPAIR
Numerous techniques for repairing urinary collecting system (UCS) injuries during RAPN have been