A prospective evaluation of the utility of laparoscopic Doppler technology during minimally invasive partial nephrectomy.
OBJECTIVE
To evaluate the objective benefits of laparoscopic Doppler ultrasound (LDU) during robotic-assisted laparoscopic partial nephrectomy (RALPN). LDU has demonstrated subjective benefits for the evaluation of vascular structures during minimally invasive renal surgery.


METHODS
An institutional review board-approved, prospective protocol was developed to compare hilar dissection time with and without LDU during RALPN. Primary endpoints included hilar dissection time and whether use of LDU changed operative management. The presence of accessory vessels (AV) on LDU and surgical dissection were recorded and compared with preoperative imaging.


RESULTS
Fifty-three consecutive patients underwent RALPN (27 + LDU, 26 -LDU). There were no significant differences in demographic or disease factors. Total time for hilar dissection in the LDU arm (LDU + dissection) was significantly less than time for hilar dissection alone in the non-LDU arm (7.2 vs 11.0 minutes, P <.05). There were no intraoperative complications and there was no difference in estimated blood loss. Seven patients (26%) in the +LDU arm had accessory vessels discovered by LDU that were not seen on preoperative imaging. Five of these vessels were renal arteries that required clamping for either global or selective ischemia. LDU revealed persistent parenchymal flow after arterial clamping in 2 cases, allowing for successful double clamping or clamping of an accessory artery subsequently identified. LDU findings changed operative management in 7 of 27 patients (26%).


CONCLUSIONS
LDU reduced time for hilar dissection, improved sensitivity for hilar vessel detection, and changed operative management based on findings. This evidence supports the use of LDU during minimally invasive partial nephrectomy.
Department of Urology, New York University School of Medicine, New York, New York, USA.
Elias S
ES
Hyams
Mark
M
Perlmutter
Michael D
MD
Stifelman
D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009392:Nephrectomy / Q000379:methods*; D012371:Robotics; D018608:Ultrasonography, Doppler / Q000295:instrumentation*; D018084:Ultrasonography, Interventional