The Evolution of Tumor Enucleation Partial Nephrectomy: A Comparison of Perioperative Outcomes for Sutureless Hemostatic Bandage as an Alternative to Standard Renorrhaphy

Background The standard approach to hemostasis during partial nephrectomy (PN) is to perform suture renorrhaphy (SR). Application of a hemostatic bandage (HB) is an alternative maneuver to minimize blood loss and devitalized renal parenchyma. We aim to evaluate perioperative outcomes of PN with tumor enucleation (TE) comparing SR to HB. Methods We analyzed a retrospective cohort of 195 patients undergoing robot-assisted laparoscopic PN with TE performed by a single surgeon at a tertiary referral center (2012–2022). Hemostasis of the enucleation bed was obtained with SR in 54 patients while 141 patients underwent application of HB consisting of Surgicel®, Gelfoam® soaked in thrombin, and Floseal®. Patient factors, tumor characteristics, and perioperative outcomes were compared using Student’s t-tests and chi-squared tests. Temporal trends were evaluated using Spearman coefficients. Results Over time, there was a significant decrease in utilization of SR in favor of HB (p < 0.001). 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 the HB group. There was no significant difference in major 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/1.73m2 at 3-months postoperatively for HB and SR, respectively (p = 0.93). Conclusions Application of a HB is a safe alternative to SR for hemostasis following PN with TE in appropriately selected patients.