Sutureless laparoscopic heminephrectomy using laser tissue soldering.
OBJECTIVE
Widespread application of laparoscopic partial nephrectomy has been limited by the lack of a reliable means of attaining hemostasis. We describe laser tissue welding using human albumin as a solder to control bleeding and seal the collecting system during laparoscopic heminephrectomy in a porcine model.


METHODS
Laparoscopic left lower-pole heminephrectomy was performed in five female domestic pigs after occluding the hilar vessels. Using an 810-nm pulsed diode laser (20 W), a 50% liquid albumin-indocyanine green solder was welded to the cut edge of the renal parenchyma to seal the collecting system and achieve hemostasis. Two weeks later, an identical procedure was performed on the right kidney, after which, the animals were sacrificed and both kidneys were harvested for ex vivo retrograde pyelograms and histopathologic analysis.


RESULTS
All 10 heminephrectomies were performed without complication. The mean operative time was 82 minutes, with an average blood loss of 43.5 mL per procedure. The mean warm ischemia time was 11.7 minutes. For each heminephrectomy, a mean of 4.2 mL of solder was welded to the cut parenchymal surface. In three of the five acute kidneys and all five 2-week kidneys, ex vivo retrograde pyelograms demonstrated no extravasation. In addition, no animal had clinical evidence of urinoma or delayed hemorrhage. Histopathologic analysis showed preservation of the renal parenchyma immediately beneath the solder.


CONCLUSIONS
Laser tissue welding provided reliable hemostasis and closure of the collecting system while protecting the underlying parenchyma from the deleterious effect of the laser during porcine laparoscopic heminephrectomy.
Ogan
Kenneth
K
Department of Urology, The University of Texas Southwestern Meidcal Centre, Dalla, Texas 75390-9110, USA.
Jacomides
Lucas
L
Saboorian
Hossein
H
Koeneman
Kenneth
K
Li
Yingming
Y
Napper
Cheryl
C
Hoopman
John
J
Pearle
Margaret S
MS
Cadeddu
Jeffrey A
JA
D000418:Albumins / Q000627:therapeutic use; D000818:Animals; D001707:Biopsy, Needle; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004195:Disease Models, Animal; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods*; D007150:Immunohistochemistry; D007668:Kidney / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D017075:Laser Coagulation / Q000379:methods*; D019060:Minimally Invasive Surgical Procedures / Q000379:methods; D009392:Nephrectomy / Q000379:methods*; D018570:Risk Assessment; D013552:Swine; D016896:Treatment Outcome
D000418:Albumins