Novel high-intensity focused ultrasound clamp--potential adjunct for laparoscopic partial nephrectomy.
OBJECTIVE
Partial nephrectomy (PN) can be technically challenging, especially if performed in a minimally invasive manner. Although ultrasound technology has been shown to have therapeutic capabilities, including tissue ablation and hemostasis, it has not gained clinical use in the PN setting. The purpose of this study is to evaluate the ability of a high-intensity ultrasound clamp to create an ablation plane in the kidney providing hemostasis that could potentially aid in laparoscopic PN.


METHODS
A new instrument was created using a laparoscopic Padron endoscopic exposing retractor. Ultrasound elements were engineered on both sides of the retractor to administer high-intensity ultrasound energy between the two sides of the clamp. This high-intensity focused ultrasound (HIFU) clamp was placed 2 to 2.5 cm from the upper and lower poles of 10 porcine kidneys to evaluate its effectiveness at different levels and duration of energy delivery. PN transection was performed through the distal portion of the clamped margin. Kidneys postintervention and after PN were evaluated and blood loss estimated by weighing gauze placed at the defect. Histologic analysis was performed with hematoxylin and eosin and nicotinamide adenine dinucleotide staining to evaluate for tissue viability and thermal spread.


RESULTS
Gross parenchymal changes were seen with obvious demarcation between treated and untreated tissue. Increased ultrasound exposure time (10 vs 5 and 2 min), even at lower power settings, was more effective in causing destruction and necrosis of tissue. Transmural ablation was achieved in three of four renal units after 10 minutes of exposure with significantly less blood loss (<2 g vs 30-100 g). Nonviable tissue was confirmed histologically. There was minimal thermal spread outside the clamped margin (1.2-3.2 mm).


CONCLUSIONS
In this preliminary porcine evaluation, a novel HIFU clamp induced hemostasis and created an ablation plane in the kidney. This technology could serve as a useful adjunct to laparoscopic PN in the future and potentially obviate the need for renal hilar clamping.
Department of Urology, University of Washington School of Medicine, Seattle, Washington, USA. jdharper@uw.edu
Jonathan D
JD
Harper
Anup
A
Shah
Stuart B
SB
Mitchell
Yak-Nam
YN
Wang
Frank
F
Starr
Michael R
MR
Bailey
Lawrence A
LA
Crum
D000818:Animals; D057086:High-Intensity Focused Ultrasound Ablation / Q000295:instrumentation*; D007668:Kidney / Q000473:pathology / Q000601:surgery; D010535:Laparoscopy; D009392:Nephrectomy; D013525:Surgical Instruments; D034421:Sus scrofa / Q000601:surgery