Single Instrument for Hemostatic Control in Laparoscopic Partial Nephrectomy in a Porcine Model Without Renal Vascular Clamping * (original) (raw)
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Urology, 2001
Objectives. Laparoscopic partial nephrectomy (LPN) has generally been reserved for small exophytic lesions because of the limited hemostatic capabilities when excising large segments of renal parenchyma. To overcome this problem, we investigated a technique of laparoscopic reversible, regional hypoperfusion using a cable-tie to minimize blood loss and optimize exposure. Methods. Ten domestic pigs underwent LPN after securing a cable-tie around one pole of the kidney and tightening it until the distal parenchymal surface blanched completely. Eight large amputations involving the collecting system and eight smaller amputations excluding the collecting system were performed using laparoscopic scissors. Fibrin glue was applied to seal the cut surface prior to cable-tie removal. Four pigs (4 large and 4 small amputations) were killed immediately and methylene blue was injected retrograde into the ureter to identify collecting system leaks. The remaining 6 pigs (4 large and 4 small amputations) were killed 4 weeks later and retrograde urograms were performed to assess collecting system integrity. Results. Median cable-tie ischemia time was 15 minutes (range 7 to 48) and median blood loss was 30 mL (range 10 to 300). In each case, hemostasis was attained with fibrin glue. In the survival group, all 4 small amputations healed with a fibrotic scar. In the large amputation group, 1 animal died from urinary extravasation on postoperative day 4. The collecting systems of the remaining 3 pigs sealed completely. Conclusions. In the porcine model, cable-tie-assisted LPN provides an almost bloodless surgical field that facilitates rapid resection of large renal segments and hemostasis during a short ischemic period. We anticipate that this technique will broaden the clinical application of LPN. UROLOGY 57: 562-566, 2001.
Radiofrequency-assisted laparoscopic partial nephrectomy: clinical and histologic …
Journal of …
To evaluate a surface conductive radiofrequency (RF) coagulation instrument (Tissuelink FB3.0) in laparoscopic and open partial nephrectomy (PN) in hereditary kidney cancer. The lesion depth and viability in the pathologic specimens from a surgical series and an acute porcine model were characterized under conditions of vascular perfusion and occlusion.
Journal of Endourology, 2008
Objective: HABIB 4X™ is a laparoscopic focal radiofrequency-coagulation (FRFC) device utilized in liver and kidney resections to facilitate dissection while minimizing blood loss. We evaluated the ergonomics and safety of a laparoscopic FRFC device for a non-ischemic laparoscopic partial nephrectomy (LPN) in a survival porcine model. Methods: Five female pigs (10 renal units) underwent 14 laparoscopic transperitoneal partial nephrectomies using the laparoscopic FRFC device without hilar clamping. In phase 1, either one or multiple segments of the lower, upper, or middle pole were resected following FRFC of the resection plane. Large entries into the collecting system were sutured, while very small rents were left open. Following 2-week survival, a laparoscopic FRFC-assisted heminephrectomy without hilar clamping was performed on the opposite renal unit (phase 2). Both kidneys were then harvested for histologic examination. Retrograde pyelography (RGP) was used to assess the collecting system integrity of the kidneys treated in phase 1. Results: All 14 LPNs were performed successfully without hilar clamping or open conversion. On average, the resected segments comprised 12.3% of the kidney in phase 1 and 34.8% in phase 2, with a mean estimated blood loss of 45 mL and 76.5 mL, respectively. At harvest, no hematomas or perinephric collections were observed. RGP revealed urinary extravasation in two renal units that were not repaired. Histologic examination of the resection margin revealed hemorrhage and inflammation with some hyalinization of the proximal and distal tubules, none extending deeper than 3 mm. Conclusion: The FRFC-assisted non-ischemic porcine LPN is feasible and safe and can be accomplished with minimal bleeding, even with large resections. The laparoscopic FRFC device holds promise in decreasing the inherent difficulty of LPN by obviating the need for laparoscopic suturing to control small parenchymal vessels, as well as in reducing the deleterious effects of warm renal ischemia. Clinical evaluation of this device is warranted.
Radiofrequency-assisted laparoscopic partial nephrectomy: clinical and histologic results
Journal of …, 2007
To evaluate a surface conductive radiofrequency (RF) coagulation instrument (Tissuelink FB3.0) in laparoscopic and open partial nephrectomy (PN) in hereditary kidney cancer. The lesion depth and viability in the pathologic specimens from a surgical series and an acute porcine model were characterized under conditions of vascular perfusion and occlusion.
Partial renal resection by LaparoNewPro: in vivo open and laparoscopic study in an animal model
Minimally invasive therapy & allied technologies : MITAT : official journal of the Society for Minimally Invasive Therapy, 2017
The aim of this research project was to test an incremental bipolar radiofrequency generator with open and laparoscopic inline electrode probe for partial renal resection without vascular clamping. Sixteen polar resections with clamping and six without were performed in four pigs in the acute phase. Three pigs underwent laparoscopic polar resection and were live housed for ten days and reoperated to verify the presence of hematic and urinary collection and the condition of the renal edge. Five pigs underwent laparoscopic polar resection without clamping, and two of these were live housed and reoperated after ten days. Polar renal resection by our system (LaparoNewPro) turned out to be effective and safe, without cardio-respiratory complications or damage to the remaining parenchyma. Coagulation of the renal parenchyma before resection is effective and safe; at the reoperation, no complications were observed. The laparoscopic version of the probe is ergonomic and safe, with effective...
Nonischemic Laparoscopic Partial Nephrectomy Using a Novel Wet Monopolar Device in a Porcine Model
Journal of Endourology, 2012
Background and Purpose: Laparoscopic partial nephrectomy (LPN) is the minimally invasive standard of care for the management of a cT 1a renal mass. We evaluated a novel saline enhanced electrosurgical resection (SEER) device for performance of a nonischemic LPN. Materials and Methods: Six pigs were used in a nonsurvival pilot study. Energy penetration was characterized by applying the SEER to the lower pole of each kidney for 30 seconds, 1 minute, and 3 minutes using pure cutting energy at 100W and a drip rate of 1 drip per second. Energy testing was performed with the hilum clamped in six kidneys and without clamping in six kidneys. Subsequently, a nonischemic upper pole LPN was performed with the SEER device, and the kidneys were harvested. The areas of necrosis were sectioned and stained with hematoxylin and eosin. Depth of necrosis was visualized grossly and microscopically for each time point. We also recorded time to perform LPN, estimated blood loss (EBL), and subjective severity of bleeding. Results: The average operative time was 15.4 minutes. The mean EBL was 44.2 mL with nine (75%) cases classified as minimal, 2 (17%) moderate, and 1 (8%) severe bleeding. The mean depth of necrosis on the kidney remnants was 2.97 mm. The mean depth of necrosis for unclamped kidneys at 30 seconds, 1 minute, and 3 minutes was 0.38 mm, 0.88 mm, and 1.27 mm, respectively. The mean depths for the clamped kidneys were 2.73mm, 3.23mm, and 8.68mm respectively. Depth of necrosis was significantly higher in the clamped kidneys at 3 minutes (P = 0.0035). Conclusions: In the porcine model, the SEER transected parenchyma and collecting system with low resection times and minimal blood loss. Use of coagulation during resection is the main advantage of a monopolar resection compared with cold scissors. Testing performed for 3 minutes during hilar clamping demonstrated a significantly deeper level of necrosis.
Hemostatic laparoscopic partial nephrectomy: cable-tie compression
Urology, 2001
Objectives. Laparoscopic partial nephrectomy (LPN) has generally been reserved for small exophytic lesions because of the limited hemostatic capabilities when excising large segments of renal parenchyma. To overcome this problem, we investigated a technique of laparoscopic reversible, regional hypoperfusion using a cable-tie to minimize blood loss and optimize exposure. Methods. Ten domestic pigs underwent LPN after securing a cable-tie around one pole of the kidney and tightening it until the distal parenchymal surface blanched completely. Eight large amputations involving the collecting system and eight smaller amputations excluding the collecting system were performed using laparoscopic scissors. Fibrin glue was applied to seal the cut surface prior to cable-tie removal. Four pigs (4 large and 4 small amputations) were killed immediately and methylene blue was injected retrograde into the ureter to identify collecting system leaks. The remaining 6 pigs (4 large and 4 small amputations) were killed 4 weeks later and retrograde urograms were performed to assess collecting system integrity. Results. Median cable-tie ischemia time was 15 minutes (range 7 to 48) and median blood loss was 30 mL (range 10 to 300). In each case, hemostasis was attained with fibrin glue. In the survival group, all 4 small amputations healed with a fibrotic scar. In the large amputation group, 1 animal died from urinary extravasation on postoperative day 4. The collecting systems of the remaining 3 pigs sealed completely. Conclusions. In the porcine model, cable-tie-assisted LPN provides an almost bloodless surgical field that facilitates rapid resection of large renal segments and hemostasis during a short ischemic period. We anticipate that this technique will broaden the clinical application of LPN. UROLOGY 57: 562-566, 2001.
Controlled Study of Inline Radiofrequency Coagulation-Assisted Partial Nephrectomy in Sheep
Journal of Surgical Research, 2006
Background. Primary or secondary tumors of kidney often are managed by partial nephrectomy. Intraoperative blood loss can be significant. Laparoscopic partial nephrectomy may be even more challenging. We developed the Inline radiofrequency coagulation (ILRFA) probe for liver surgery. It uses radiofrequency energy to make a linear coagulative plane and considerably reduces bleeding during parenchymal transection. In this stud,y we tested the efficiency of ILRFA in ovine kidney.
A simple and reliable hemostatic technique during partial nephrectomy
Urology, 2004
To report our experience with a refined technique for hemostasis that obviates the need for vascular control and closure of the collecting system in partial nephrectomy. Four to five sutures, 2 cm apart, are placed 0.5 cm from the anticipated parenchymal incision border, using a specially designed, blunt-tip, straight needle with folded 2-0 Vicryl thread. The needle is removed, leaving the Vicryl thread with the loop on one side of the kidney and two free ends on the other side. A 1.0-cm-wide Vicryl mesh strip is passed circumferentially through the loops and between the free ends on each side, tension is applied on the strip during knotting of the free ends of the thread, and the tissue is incised. No additional hemostatic sutures are necessary. No attempt is made to identify and close the open collecting system. Vascular clamping and surface cooling are avoided. Sixty-one patients have undergone this technique since 1987: initially, for complicated nephrolithiasis (n = 15), locali...
European Journal of Surgical Oncology (EJSO), 2008
Background: Efficient and safe liver parenchymal transection is dependent on the ability to address both parenchymal division and hemostasis simultaneously. In this article we describe and compare with a saline-linked instrument a new radiofrequency (RF)-assisted device specifically designed for tissue thermocoagulation and division of the liver used on an in vivo pig liver model. Methods: In total, 20 partial hepatectomies were performed on pigs through laparotomy. Two groups were studied: group A (n ¼ 8) with hepatectomy performed using only the proposed RF-assisted device and group B (n ¼ 8) with hepatectomy performed using only a salinelinked device. Main outcome measures were: transection time, blood loss during transection, transection area, transection speed and blood loss per transection area. Secondary measures were: risk of biliary leakage, tissue coagulation depth and the need for hemostatic stitches. Tissue viability was evaluated in selected samples by staining of tissue NADH. Results: In group A both blood loss and blood loss per transection area were lower ( p ¼ 0.001) than in group B (70 AE 74 ml and 2 AE 2 ml/ cm 2 vs. 527 AE 273 ml and 13 AE 6 ml/cm 2 , for groups A and B, respectively). An increase in mean transection speed when using the proposed device over the saline-linked device group was also demonstrated (3 AE 0 and 2 AE 1 cm 2 /min for group A and B, respectively) ( p ¼ 0.002). Tissue coagulation depth was greater ( p ¼ 0.005) in group A than in group B (6 AE 2 mm and 3 AE 1 mm, for groups A and B, respectively). Neither macroscopic nor microscopic differences were encountered in transection surfaces between both groups. Conclusions: The proposed RF-assisted device was shown to address parenchymal division and hemostasis simultaneously, with less blood loss and faster transection time than saline-linked technology in this experimental model.