title: Less smoke and minimal tissue carbonization using a thulium laser for laparoscopic partial nephrectomy without hilar clamping in a porcine model.
abstract: OBJECTIVE
  We evaluated the utility of a thulium laser and a novel implementation of its use for laparoscopic partial nephrectomy to achieve precise, smokeless, and hemostatic dissection without hilar clamping and with minimal charring in a porcine model.
  
  
  METHODS
  Laparoscopic transperitoneal lower-pole partial nephrectomy was performed in five Yorkshire farm pigs without clamping of the renal hilum. All animals were kept alive for 1 week. Using a 365-mum laser fiber, a 30 W thulium laser was used to produce full-thickness cortical excisions of the lower-pole renal cortex. The laser fiber was delivered through the working channel of a 16F flexible cystoscope inserted through a 10-mm laparoscopic port. The laser incision was directed by manual deflection of the cystoscope along with low-pressure saline irrigation through the cystoscope.
  
  
  RESULTS
  Laparoscopic partial nephrectomy was completed in all cases without perioperative complications and with an estimated blood loss of <50 mL. The thulium laser was able to cut tissue and simultaneously to coagulate vessels as large as 1.6 mm. The flexible cystoscope with concurrent saline irrigation permitted precise laser control for dissection with minimal tissue charring and no smoke to obscure visibility. At 1 week, the cut edge of the tissue showed minimal necrosis with preservation of histologic architecture.
  
  
  CONCLUSIONS
  Laparoscopic partial nephrectomy with the thulium laser provides precise dissection and hemostasis without hilar clamping. Minimal tissue charring and no smoke generation improve visibility.
authors.affiliation: mattbui@gmail.com
authors.forename: Matthew H
authors.initials: MH
authors.lastname: Bui
authors.forename: Alberto
authors.initials: A
authors.lastname: Breda
authors.forename: Dorina
authors.initials: D
authors.lastname: Gui
authors.forename: Johnathan
authors.initials: J
authors.lastname: Said
authors.forename: Peter
authors.initials: P
authors.lastname: Schulam
mesh_terms: D000818:Animals; D003558:Cystoscopy / Q000379:methods; D005260:Female; D020706:Laparoscopes; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000295:instrumentation*; D007834:Lasers; D009392:Nephrectomy / Q000379:methods*; D010710:Phosphates; D012906:Smoke; D013514:Surgical Procedures, Operative / Q000379:methods; D013552:Swine; D013932:Thulium / Q000737:chemistry*; D014025:Titanium
chemical_list: D010710:Phosphates; D012906:Smoke; C064806:potassium titanylphosphate; D013932:Thulium; D014025:Titanium