Water jet assisted laparoscopic partial nephrectomy without hilar clamping in the calf model.
OBJECTIVE
Hemostasis represents a primary challenge during laparoscopic partial nephrectomy (LPN). We typically clamp the renal artery/vein en bloc and perform LPN expeditiously under warm ischemia conditions. We evaluated Helix Hydro-jet assisted LPN without renal hilar vascular control in the survival calf model.


METHODS
Staged bilateral LPN using the Hydro-jet was performed without renal hilar vessel control in 10 survival calves (20 kidneys). Parenchymal hydrodissection was performed with a high velocity, ultracoherent saline stream at 450 psi through a small nozzle with integrated suction at the tip. The denuded intrarenal parenchymal blood vessels were precisely coagulated with a BIClamp bipolar instrument and transected. Followup involved biochemical, radiological and histopathological evaluation at designated sacrifice intervals of 1 and 2 weeks, and 1, 2 and 3 months, respectively.


RESULTS
All LPNs were completed successfully without open conversion. Of 20 LPNs 18 (90%) were performed without hilar clamping. Pelvicaliceal suture repair was necessary in 5 of 10 chronic kidneys (50%). Mean Hydro-jet(R) partial nephrectomy time was 63 minutes (range 13 to 150), mean estimated blood loss was 174 cc (range 20 to 750) and mean volume of normal saline used for hydro-dissection was 260 cc (mean 50 to 1,250). No animal had a urinary leak. Histological sections from the acute specimen revealed a thin (1 mm) layer of adherent coagulum at the amputation site with minimal thermal artifact. At 2 weeks a layer of adherent fibro-inflammatory pseudomembrane with giant cell reaction was seen.


CONCLUSIONS
In this more stringent and robust survival calf model Hydro-jet assisted LPN can be performed without hilar vessel control, thus, completely avoiding warm ischemia. This approach has the potential to decrease the level of technical difficulty inherent in LPN.
Moinzadeh
Alireza
A
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute and Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio, USA.
Hasan
Waleed
W
Spaliviero
Massimiliano
M
Finelli
Antonio
A
Kilciler
Mete
M
Magi-Galluzzi
Cristina
C
El Gabry
Ehab
E
Desai
Mihir
M
Kaouk
Jihad
J
Gill
Inderbir S
IS
D000818:Animals; D002417:Cattle; D004867:Equipment Design; D006489:Hemostatic Techniques / Q000295:instrumentation; D007668:Kidney / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy / Q000379:methods; D008297:Male; D009392:Nephrectomy / Q000379:methods*; D014867:Water
D014867:Water