title: Laparoscopic partial nephrectomy using a flexible CO2 laser fiber.
abstract: OBJECTIVE
  Laparoscopic partial nephrectomy (LPN) is a challenging surgery that requires precise tissue cutting and meticulous hemostasis under warm ischemia conditions. In this study, we tested the feasibility of performing LPN using CO2 laser energy transmitted through a specialized flexible mirror optical fiber.
  
  
  METHODS
  General anesthesia and pneumoperitoneum were induced in 7 farm pigs. Various portions of a kidney, either a pole or a midportion of the kidney, were removed using a novel flexible fiber to transmit CO2 laser energy set at a power of 45W and energy per pulse of 100mJ. The collecting system was approximated with a suture or 2, but no hemostatic measures were taken besides applying a few pulses of the laser to bleeding points. The pigs were sacrificed 3 wk later.
  
  
  RESULTS
  Average renal mass removed was 18% of the total kidney weight. All pigs tolerated surgery well. Sharp renal cutting was accomplished in a single continuous incision, with minimal tissue charring and minimal blood loss (<10cc) in all animals. Necropsy revealed no peritoneal or retroperitoneal abnormalities. Histologic examination of the cut surface showed a thin sector of up to 100 m of coagulation necrosis.
  
  
  CONCLUSIONS
  We report on the first LPN done using a CO2 laser transmitted through a flexible fiber in an animal model. This novel application of the CO2 laser produced excellent parenchymal incision and hemostasis along with minimal damage to adjacent renal tissue, thus, potentially shortening ischemia time and kidney function loss. Further studies comparing this laser to standard technique are necessary to verify its usefulness for partial nephrectomy.
authors.affiliation: Department of Urology, Hadassah University Medical Center, Jerusalem, Israel. ogofrit@gmail.com
authors.forename: Ofer N
authors.initials: ON
authors.lastname: Gofrit
authors.forename: Abed
authors.initials: A
authors.lastname: Khalaileh
authors.forename: Oleg
authors.initials: O
authors.lastname: Ponomarenko
authors.forename: Mahmoud
authors.initials: M
authors.lastname: Abu-Gazala
authors.forename: Reuven M
authors.initials: RM
authors.lastname: Lewinsky
authors.forename: Ram
authors.initials: R
authors.lastname: Elazary
authors.forename: Noam
authors.initials: N
authors.lastname: Shussman
authors.forename: Arieh
authors.initials: A
authors.lastname: Shalhav
authors.forename: Yoav
authors.initials: Y
authors.lastname: Mintz
mesh_terms: D000818:Animals; D004195:Disease Models, Animal; D004867:Equipment Design; D007674:Kidney Diseases / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000295:instrumentation*; D054020:Lasers, Gas / Q000627:therapeutic use*; D009392:Nephrectomy / Q000379:methods*; D018583:Pliability; D013552:Swine