Single Instrument for Hemostatic Control in Laparoscopic Partial Nephrectomy in a Porcine Model Without Renal Vascular Clamping * (original) (raw)

Purpose: To test the viability of a new device to obtain hemostasis during laparoscopic partial nephrectomy (LPN) without vascular clamping. Materials and Methods: We performed a comparative experimental study between a new radiofrequency (RF)assisted device consisting of a handheld instrument that simultaneously conducts coagulation and cutting tasks without hilar clamping vs a standard technique with hilar clamping. A porcine model was used (10 animals per group) with survival of 17 days. Results: The estimated blood loss with the new device was significantly lower than with the standard technique (15.5-23.7 vs 79.4-76.3 mL). Although transection time was longer with the new device (10.7-13.7 vs 2.1-1.2 min), the total operative time was significantly shorter (35.3-13.7 vs 60.2-10.5 min). Evidence of localized urinary extravasation (urinoma) was identical in both groups (five cases). The group subjected to the new device, however, showed a significantly higher number of cases of leakage after conducting the methylene-blue test: eight (80%) cases vs only one (11%) with the standard technique. Necrosis depth was significantly greater with the new device (6.6-0.9 vs < 1 mm). Conclusions: The experimental results suggest that the proposed RF-assisted device provides adequate hemostatic control during transection of the renal parenchyma without additional instruments or surgical maneuvers and could therefore be a valuable adjunct for LPN without vascular clamping. The device was unsuccessful in effectively sealing the collecting system.