Hemostatic Laparoscopic Partial Nephrectomy
The following information was presented at the American Urological Association Annual Meeting in San Antonio, TX, in May 2005 by Matthew H. Bui, Alberto Breda and Peter G. Schulam. Objective: Laparoscopic partial nephrectomy is technically challenging from the standpoint of hemostatic control, often requiring extensive manipulation and control of the renal vascular hilum. We evaluated the utility of the Revolix™ laser, a novel continuous wave laser, for laparoscopic partial nephrectomy without hilar clamping in a porcine model. Methods: Laparoscopic transperitoneal lower pole partial nephrectomy was performed in 4 Yorkshire farm pigs without manipulation or clamping of the renal hilum. All animals underwent a left-sided laparoscopic partial nephrectomy and were kept alive for 1 week. Subsequently, a left laparoscopic nephrectomy was performed, and the animals were sacrificed. Using the Revolix laser, an end-fire and a side-fire 271-micron laser fiber set at 15 watts were used to produce full-thickness cortical excisions of the lower pole renal cortex. The cut parenchymal surface was evaluated for hemostasis. The cut surface was then sealed with fibrin glue. The harvested kidneys were inspected grossly and evaluated microscopically. Results: Laparoscopic partial nephrectomy was successfully completed in all cases. There were no perioperative complications in the survival group with an estimated blood loss of less than 50 cc. The Revolix end-fire and side-fire laser afforded precise dissection without tissue charring. The Revolix laser was able to seal vessels up to 1.5 mm in size. In the survival group, serum creatinine levels showed no significant changes post-operatively. Conclusions: The novel continuous wave Revolix™ laser provides excellent hemostatic control for precise dissection of the renal cortex without vascular hilum clamping. For use in humans, this laser would be well suited for laparoscopic excision of exophytic lesions limited to the ren
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