The Use of Self Retaining Sutures in Open and Laparoscopic Partial Nephrectomy
The Use of Self Retaining Sutures in Open and Laparoscopic Partial Nephrectomy
The objective of this study is to assess whether using a different type of suture (barbed
 sutures) during partial nephrectomy results in fewer postoperative complications than with
 traditional sutures (non-barbed). The most common complications are urine leakage and
 bleeding. The investigators believe the barbed suture is less technically difficult to use
 and will allow the surgeon to better repair the hole left in the kidney after the tumor is
 removed.
With the increased use of radiographic imaging for abdominal complaints the incidental
 finding of small asymptomatic renal masses has increased. Partial nephrectomy has become the
 gold standard therapy for treatment of kidney masses ≤7cm in size. Absolute indications for
 partial nephrectomy include bilateral renal tumors, systemic condition affecting renal
 function, chronic renal insufficiency and solitary kidney function. Elective indications
 include masses ≤7cm and normal contralateral kidney function. The procedure can be completed
 through either laparoscopic or open technique. Complication rates from open and partial
 nephrectomy have been reported to be about 16% with the most common being urinary leak,
 postoperative bleeding, renal insufficiency and the need for dialysis.

 A major predictor of postoperative complications is the warm ischemia time. This is the
 length of time the kidney is without blood flow at body temperature. It has been reported
 that renal and cellular damage of the nephron begins after 20-30 minutes of ischemia. As
 well, the volume of estimated blood loss has been shown to be a major predictor of
 postoperative complications. A threshold value of estimated blood loss >750 mL and warm
 ischemia time >45 minutes have been associated with significantly increased rates of
 postoperative complications. Recent advancements in laparoscopic technique have lead to the
 development of the early unclamping method of partial nephrectomy. In this method the renal
 pedicle is unclamped following the initial central running suture but before the defect has
 been entirely repaired with bolstering sutures. This method has been reported to decrease
 warm ischemia time by ≥50% in comparison to the traditional technique of unclamping after
 full closure of the defect.

 The investigators have demonstrated the safety of the "Quill" (Angiotech, Vancouver, BC)
 polydioxanone barbed self retaining sutures in a retrospective series. These sutures contain
 unidirectionally oriented barbs on the surface that switch direction at the half-way point.
 Laparoscopic partial nephrectomy is a technically demanding procedure and maintaining tension
 during intracorporeal suturing is particularly challenging. The barbs of the self retaining
 sutures lock into the tissue allowing the surgeon to preserve tissue approximation without
 needing to maintain tension. The investigators believe these sutures will allow the surgeon
 to obtain greater tissue approximation therefore decreasing postoperative urinary leakage and
 bleeding. These findings need to be validated postoperatively.

 The investigators believe that coupling the shorter warm ischemia time of the early
 unclamping method and the greater tissue approximation afforded by the self retaining sutures
 will result in fewer complications following partial nephrectomy.
Inclusion Criteria:

 -  any person who is being treated for kidney cancer with partial nephrectomy.

 Exclusion Criteria:

 -  those from whom we cannot obtain adequate informed consent.

 -  those that are converted from partial to radical nephrectomy intraoperatively.