Sutureless versus renorrhaphy in robot-assisted off-clamp partial nephrectomy: a systematic review and meta-analysis
In brief
Sutureless off-clamp robotic partial nephrectomy matches standard renorrhaphy for composite success
A pooled analysis of one randomized trial and three matched studies found that skipping routine parenchymal suturing did not change overall Trifecta achievement compared with conventional renorrhaphy, and the trial met a non-inferiority criterion. The sutureless approach modestly reduced the immediate drop in kidney function (about 4 ml/min/1.73 m²), while complication and cancer-control rates were similar. Larger trials are needed to clarify effects on urinary leaks and long-term outcomes.
- Journal
- Journal of robotic surgery (Q1)
- Published
- 7 September 2026
- Study design
- Systematic review / meta-analysis of RCTs
- Evidence level
- Level 1, High (CEBM 1a)
- Authors
- Xiaofu Zeng, Xiaofeng Xu, Jingxian Luo, Guangqing Fu
- PMID
- 42704544
- DOI
- 10.1007/s11701-026-03931-3
Why clinicians should know about it
- Picked for Bariatric and Metabolic Surgery (top studies of the week, 13 September 2026): Not related to bariatric surgery outcomes
- Picked for Health Informatics (top studies of the week, 13 September 2026).
- Picked for Nephrology (top studies of the week, 13 September 2026): Not directly relevant to nephrology
- Picked for Urology (top studies of the week, 13 September 2026): Meta‑analysis of sutureless vs renorrhaphy in off‑clamp RAPN
Abstract
BACKGROUND: The necessity of routine parenchymal renorrhaphy during off-clamp robot-assisted partial nephrectomy (RAPN) remains uncertain. This study aimed to compare perioperative, functional, safety, and oncological outcomes between sutureless and conventional renorrhaphy. METHODS: We conducted a systematic review and meta-analysis following PRISMA 2020 guidelines. Comparative studies evaluating sutureless versus conventional renorrhaphy during purely off-clamp RAPN were included. Trifecta achievement was the primary outcome. Random-effects models were used for pooled analyses, with subgroup analysis according to study design. RESULTS: Four studies involving 787 patients, including one randomized controlled trial (RCT) and three propensity score-matched (PSM) studies, were included. The overall pooled estimate showed no statistically significant difference in Trifecta achievement (RR 1.17, 95% CI 0.97-1.41), with substantial heterogeneity (I² = 86.5%). The PSM studies favored the sutureless approach (RR 1.26, 95% CI 1.05-1.52), whereas the RCT yielded an RR of 0.97 (95% CI 0.92-1.04) and met the prespecified noninferiority criterion without demonstrating superiority. The sutureless approach was associated with a smaller perioperative eGFR decline (MD - 3.89, 95% CI - 6.16 to - 1.62), while no significant difference was observed in eGFR at 3 months. No statistically significant differences were identified in major complications, blood transfusion, or positive surgical margins; urinary and vascular complications were sparsely reported. CONCLUSIONS: In selected patients undergoing purely off-clamp RAPN, randomized evidence supports the noninferiority of a strategy that omits routine parenchymal renorrhaphy while permitting clinically necessary selective repair, but does not demonstrate superiority. Favorable estimates from PSM studies remain vulnerable to intraoperative treatment-selection bias. Current evidence is insufficient to determine whether omission of renorrhaphy affects urinary complications, long-term renal function, or oncological outcomes. REGISTRATION: This systematic review was registered prospectively in PROSPERO (CRD420261435995).
Abstract as published, via PubMed.
For healthcare professionals. The summary is generated by AI from the published abstract, and the evidence level is assigned automatically from the study design on the Oxford CEBM hierarchy. Neither is medical advice. Read the full paper before changing practice.