Laparoscopic Partial Nephrectomy With Potassium-titanyl-phosphate Laser Versus Conventional Laparoscopic Partial Nephrectomy: An Animal Randomized Controlled Trial.
OBJECTIVE
To explore the feasibility, safety, and short-term results of potassium-titanyl-phosphate (KTP) laser laparoscopic partial nephrectomy (KTP-LPN) vs conventional laparoscopic partial nephrectomy (C-LPN).


METHODS
Thirty large white female pigs were randomized to KTP-LPN or C-LPN. Laparoscopic radical right nephrectomy was performed, and an artificial renal tumor was placed in the left kidney in 3 locations. A week later, 15 pigs underwent C-LPN and 15 underwent KTP-LPN. All C-LPNs were performed with renal ischemia. A 120-W setting was used, without arterial clamping in the KTP-LPN group. Follow-up was done at day 1, week 3, and week 6. Retrograde pyelography was performed at 6 weeks, followed by animal sacrifice and necropsy.


RESULTS
All KTP-LPNs were performed without hilar clamping. C-LPNs were performed with hilar clamping, closing of the collecting system, and renorraphy. In the KTP laser group, 2 pigs died due to urinary fistula in the first week after surgery. In the C-LPN group, 1 pig died due to myocardial infarction and another due to malignant hyperthermia. Hemoglobin and hematocrit recovery were lower at 6 weeks in the KTP-LPN group. Renal function 24 hours after surgery was worse in the KTP-LPN group but recovered at 3 weeks and 6 weeks. No differences were observed in surgical margins. The necropsy showed no differences. Limitations of the study are the impossibility to analyze the collecting tissue sealing by the KTP, and the potential renal toxicity of the KTP laser.


CONCLUSIONS
Although KTP-LPN is feasible and safe in the animal model, further studies are needed.
Department of Urology, University Hospital Miguel Servet, Zaragoza, Spain. Electronic address: jrioja@unizar.es.
Jorge
J
Rioja
Minimally Invasive Surgery Center "Jesús Usón", Cáceres, Spain.
Esther
E
Morcillo
Department of Bio-medicine, Bio-technology and Public Health, Cádiz University, Spain.
José P
JP
Novalbos
Minimally Invasive Surgery Center "Jesús Usón", Cáceres, Spain.
Miguel A
MA
Sánchez-Hurtado
Minimally Invasive Surgery Center "Jesús Usón", Cáceres, Spain.
Federico
F
Soria
Minimally Invasive Surgery Center "Jesús Usón", Cáceres, Spain.
Francisco
F
Pérez-Duarte
Minimally Invasive Surgery Center "Jesús Usón", Cáceres, Spain.
Idoia
I
Díaz-Güemes Martín-Portugüés
Department of Urology, AMC University Hospital, Amsterdam, The Netherlands.
Maria Pilar
MP
Laguna
Minimally Invasive Surgery Center "Jesús Usón", Cáceres, Spain.
Francisco Miguel
FM
Sánchez-Margallo
Department of Urology, University Hospital Cádiz, Cádiz, Spain.
Federico
F
Rodríguez-Rubio Cortadellas
D000818:Animals; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000175:diagnosis / Q000601:surgery*; D010535:Laparoscopy / Q000379:methods*; D053685:Laser Therapy / Q000295:instrumentation*; D053844:Lasers, Solid-State / Q000627:therapeutic use*; D009374:Neoplasms, Experimental; D009392:Nephrectomy / Q000379:methods*; D010710:Phosphates; D013552:Swine; D014025:Titanium; D014567:Urography
D010710:Phosphates; C064806:potassium titanylphosphate; D014025:Titanium