Laparoscopic partial nephrectomy with a novel electrosurgical snare in a porcine model.
OBJECTIVE
We evaluated the safety and efficacy of laparoscopic partial nephrectomy with an arcing-gap electrosurgical snare in a porcine model.


METHODS
A novel electrosurgical snare, optimizing high current density arcing and parenchymal compression, was utilized for laparoscopic renal transection. Five farm pigs underwent unilateral laparoscopic polar partial nephrectomy; 6 weeks later, these same animals underwent contralateral partial nephrectomy just prior to sacrifice. Five additional animals underwent chronic (6-week follow-up) and acute open partial nephrectomies by the conventional surgical technique.


RESULTS
The average time for transection with the snare was 5.6 minutes. In 9 of 10 cases, the snare provided satisfactory hemostasis. In the remaining case, additional argon-beam coagulation (ABC) controlled the minimal bleeding present after transection. In all 10 animals, the collecting system was transected. In six cases, application of the snare alone sealed the collecting system. No urinomas developed in the five animals followed for 6 weeks. At 6 weeks, the mean depth of injury at the center of the cut surface was 5.1 mm in the laparoscopic group and 3.9 mm in the open group.


CONCLUSIONS
Laparoscopic partial nephrectomy with the arcing-gap electrosurgical snare is feasible in a porcine model. Application of the snare provides excellent hemostasis without the need to control the renal vasculature.
Collyer
William C
WC
Division of Urology, Washington University School of Medicine, St. Louis, Missouri, USA.
Landman
Jaime
J
Olweny
Ephrem O
EO
Andreoni
Cassio
C
Kibel
Adam
A
Andriole
Gerald L
GL
Bostwick
David G
DG
Sundaram
Chandru P
CP
Clayman
Ralph V
RV
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control; D004564:Electrocoagulation / Q000295:instrumentation* / Q000379:methods; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation* / Q000379:methods; D007150:Immunohistochemistry; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures; D023421:Models, Animal; D009392:Nephrectomy / Q000295:instrumentation / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D012680:Sensitivity and Specificity; D013525:Surgical Instruments; D013552:Swine