Feasibility of Omitting Outer Renorrhaphy During Robotic Partial Nephrectomy

Introduction: Reconstruction technique after robotic partial nephrectomy (RPN) is a modifiable factor with possible impact on ischemia time, bleeding, renal function, and incidence of pseudoaneurysms. We sought to evaluate the feasibility of omitting cortical (outer) renorrhaphy (CR) in a multi-institutional setting.Methods: We analyzed 1453 patients undergoing RPN, from 2006-2018, within the Vattikuti Collective Quality Initiative database, which captures that data from 14 centers in 9 countries. Patients having surgery for bilateral tumors(n=73) were excluded. The CR and no-CR groups were compared in terms of operative and ischemia time, blood loss, major (Clavien≥3) complications, surgical margins, hospital stay, change in estimated glomerular filtration rate (eGFR), and need of angioembolization. Inverse probability of treatment weighting (IPTW) with a Firth correction for center code was done to account for selection bias.Results: CR was omitted in 120 patients; 1260 patients underwent both inner (base) layer renorrhaphy and CR. There was no difference in intraoperative complications (7.4% in CR; 8.9% in no-CR group;p=0.6) or postoperative major complications (1% and 2.8% in the CR and no-CR groups, respectively;p=0.2). Estimated blood loss was 100 mL (IQR 50-200) in both treatment groups(p=0.6). Angioembolization was needed in 0.7% patients in CR group vs 1.4% in no-CR group(p=0.4). Additionally, there was no difference in median operative time (168 minutes and 162 minutes, respectively;p=0.2), or ischemia time (18 minutes and 17 minutes, respectively;p=0.7). Conclusions: Omission of CR did not significantly improve operative or ischemia time; however, it also had no adverse effect on perioperative outcomes after RPN in a multi-institutional setting.