Application of a Non-Clamping Sutureless Technique Combined with Radiofrequency Ultrasound Scalpel in Laparoscopic Nephron-Sparing Surgery for T1 Renal Cell Carcinoma: A Retrospective Cohort Study

ObjectiveThis study aimed to assess renal cell carcinoma (RCC) complexity using the R.E.N.A.L. nephrometry score and evaluate the feasibility and safety of the non-clamping sutureless technique combined with a radiofrequency ultrasound scalpel (RFUS) for low-complexity RCC.MethodsThis retrospective, multi-center cohort study categorized patients into three groups: Group I (suture laparoscopic partial nephrectomy [LPN] with clamping renal artery), Group II (sutureless LPN without renal artery clamping, combined with monopolar electrocoagulation), and Group Ⅲ (sutureless laparoscopic nephron-sparing surgery [LNSS] without renal artery clamping combined with RFUS). Key outcomes included operative time, intraoperative blood loss, postoperative hospital stays, serum creatinine (Scr) levels, and the estimated glomerular filtration rate (eGFR) of the affected kidney. Post hoc power analysis was used to evaluate eGFR variation across groups, and a multiple linear regression model was employed to analyze factors influencing postoperative eGFR alterations.ResultsThe study included 60 patients with exophytic and low-complexity RCC. Blood loss in Group III was comparable to that in Group I but less than that in Group II (<i>P</i> = 0.035). Operative time and postoperative hospital stays were significantly shorter in Group III than in the other groups (<i>P</i> < 0.01). A statistically significant increase in Scr levels was observed during the early postoperative period, continuing through the 6-month follow-up assessment compared with preoperative levels (<i>P</i> < 0.01). The 6-month postoperative eGFR of the affected kidney in Group III was significantly higher than that in the other groups (<i>P</i> < 0.01). The decrease in preoperative and 6-month postoperative eGFR values was greatest in Group I (<i>P</i> < 0.01), followed closely by Group II (<i>P</i> < 0.01), while no significant reduction was observed in Group III. The post hoc power analysis revealed high detection power (0.912 or 1.0). Warm ischemia time emerged as the sole significant eGFR predictor (<i>R²</i> = 0.814, <i>P</i> < 0.05).ConclusionThe non-clamping sutureless technique combined with RFUS for RCC effectively alleviates renal ischemia-reperfusion injury, offering superior renal function protection while achieving comparable oncological outcomes.