In a robotic partial nephrectomy (RPN), will there be scarring, surgical clips, or both?

Robotic Partial Nephrectomy: Expected Scarring and Surgical Clips

Yes, robotic partial nephrectomy will result in both external scarring from port sites and internal surgical clips used for parenchymal reconstruction.

External Scarring

Robotic partial nephrectomy is performed through small port incisions, which will leave visible scars on the skin:

• Port site scars: Typically 3-5 small incisions (8-12mm each) are made in the abdomen for robotic instrument access 1
• Transperitoneal approach (most common for anterior/lateral tumors) places ports across the anterior abdomen 2, 1
• Retroperitoneal approach (for posterior tumors) places ports in the flank region 2
• These scars are significantly smaller than the 10-20cm incision required for open partial nephrectomy 2

Internal Surgical Clips

Surgical clips are a standard and essential component of the reconstruction technique:

Hem-o-lok Clips for Parenchymal Reconstruction

The modified pledget clip technique is the standard approach for renal reconstruction during robotic partial nephrectomy 2, 3:

• Hem-o-lok clips are placed on No. 0 polyglactin sutures to secure the renal parenchyma 2
• Typically 6-8 clips are used per procedure to reinforce parenchymal sutures 3
• These clips are pulled flush against the renal capsule and serve to maintain tight hemostatic compression over cellulose bolsters 2
• The clips prevent suture tearing or pulling through the renal capsule during knot tying 2

Alternative Sliding-Clip Technique

Some surgeons use a sliding-clip renorrhaphy technique 4:

• Weck Hem-O-Lock clips are slid into place under surgeon control at the console 4
• Secured with LapraTy clips 4
• This technique significantly reduces warm ischemia time (mean 17.8 minutes) compared to traditional tied-suture closures 4

Additional Internal Materials

Beyond clips, other materials remain in the kidney after surgery:

• Absorbable sutures: 2-zero and No. 0 polyglactin sutures are used for collecting system repair and parenchymal reconstruction 2, 3
• Oxidized regenerated cellulose bolsters: Placed in the partial nephrectomy bed to fill the defect and provide hemostasis 2, 3
• Hemostatic bioadhesive agents: May be applied to the surface (though not used in all series) 2, 3

Clinical Implications

Imaging Considerations

• Surgical clips will be permanently visible on CT scans and X-rays as metallic densities 2
• This is expected and normal; clips help radiologists identify the surgical site during surveillance imaging 2
• Clips do not interfere with MRI imaging in most cases, though some artifact may occur

Long-Term Outcomes

The use of clips and absorbable sutures in robotic partial nephrectomy is associated with excellent outcomes 5:

• 5-year cancer-specific survival of 97.8% 5
• Glomerular filtration rate preservation of 87.8% 5
• Positive surgical margin rate of only 1.7% 5

Common Pitfalls to Avoid

Do not confuse surgical clips with recurrent tumor on follow-up imaging—clips remain stable in size and position over time, while tumors grow 2. Baseline postoperative imaging at 1 month helps establish the normal post-surgical appearance 2, 1.