[Ring suture technique for renorrhaphy during partial nephrectomy in the management of renal hilar cancer].

OBJECTIVE: To evaluate the safety and efficacy of "ring suture technique" during partial nephrectomy in the management of renal cell cancer located in renal hilar.

METHODS: The data of 31 patients with renal cell cancer located in renal hilar who underwent partial nephrectomy from January 2009 to January 2014 in Peking University First Hospital were collected. Of the 31 patients, 21 were male, 10 were female ranging from 48 to 75 years (average age of (58±13) years). "Ring suture technique" was adopted in all the operation which were performed following the same steps: a ureteral catheter was placed into ipsilateral ureter pre-operatively; renal artery was clamped first and after 30 s renal vein was also clamped; tumor was resected from kidney; the edge of renal parenchyma was sutured continuously; methylthioninium Chloride solution was injected into pelvis retrograde through the ureteral catheter, and the collecting system was repaired if needed; remove renal vein clamp and then the renal artery, repair any injury of the vascular when necessary. The renal ischemic time, blood loss and postoperative complications were analyzed retrospectively.

RESULTS: Retroperitoneal laparoscopic surgery and laparotomy were performed in 14 patients and 17 patients each. Average maximum diameter of tumor was (3.3±1.2) cm, and median R.E.N.A.L.nephrometry score was 8 (7-11). Average ischemic time was (24±8) minutes (18.4-37.5 minutes). Median blood loss during operation was 130 ml (90-350 ml), average blood loss was (125±45) ml, and there was no uncontrollable massive bleeding. Radical nephrectomy was adopted in 1 case due to tumor embolus in branch of renal vein. All patients had good recovery after surgery without complications such as hemorrhage, urine leakage or renal atrophy during the first 3 months after surgery.

CONCLUSION: Ring suture technique is a safe and effective method in the management of renal hilar cancer during partial nephrectomy.