Laparoscopic partial nephrectomy with a diode laser: porcine results.
OBJECTIVE
To develop a safe and effective technique for laparoscopic partial nephrectomy without need for hilar occlusion.


METHODS
Laparoscopic transperitoneal lower-pole partial nephrectomy was performed in five 45- to 50-kg female farm pigs using a 980-nm diode laser. Standard transperitoneal access was obtained, and a four-port approach was used to perform a laparoscopic right partial nephrectomy using a diode laser (23 W) without hilar occlusion. The pigs were allowed to recover and 2 weeks later underwent a left laparoscopic partial nephrectomy. Postoperatively, renal function was monitored by serial serum creatinine measurements. Both kidneys and ureters were removed for ex-vivo retrograde pyelograms and histologic analysis.


RESULTS
The 980-nm diode laser resulted in successful lower-pole partial nephrectomy without hilar occlusion in all 10 of the kidneys. In three cases, laser hemostasis was insufficient, and adjunctive hemostatic clips were necessary to stop bleeding. The mean operative time was 126 minutes, and the mean laser time was 84 minutes. An average of 23% (range 13%-33%) of the kidney parenchyma was resected. The mean blood loss was 150 mL (range 50-300 mL). There was no evidence of urinary extravasation on ex-vivo retrograde pyelograms at 2 weeks in any of the kidneys.


CONCLUSIONS
Laparoscopic partial nephrectomy without hilar occlusion using the 980-nm diode laser is feasible in the porcine model. Because adjunctive hemostatic measures may be necessary in some cases, clinical trials in humans should be limited to small exophytic tumors.
Ogan
Kenneth
K
The Clinical Center for Minimally Invasive Urologic Cancer Treatment, The University of Texas Southwestern Medical Center, Dallas 75390, USA.
Wilhelm
David
D
Lindberg
Guy
G
Lotan
Yair
Y
Napper
Cheryl
C
Hoopman
John
J
Pearle
Margaret S
MS
Cadeddu
Jeffrey A
JA
D000818:Animals; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D007668:Kidney / Q000473:pathology; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000295:instrumentation*; D009392:Nephrectomy / Q000379:methods*; D013552:Swine