Objective To evaluate in an animal model the haemostatic ef®cacy of vaporizing-cutting (VC) electrodes recently developed for use in high-energy transurethral resection of the prostate (TURP). Materials and methods Four VC electrodes were assessed for their haemostatic ef®cacy in the muscle and liver of pigs (in vitro) and dogs (in vivo). The devices tested were the roller-cutting and Vapor Cut (Karl Storz GmbH, Germany); the Wedge (Boston Scienti®c Corp., Boston, USA); and the Uroloop (Endocare Inc., Irvine, CA). In each the depth of the desiccated zone was compared with that produced by a standard cutting loop electrode. Each electrode was attached to a scanning system (developed previously) that allowed the electrode pressure on the tissue surface (in 3% sorbitol solution) and the running speed to be adjusted. The same generator was used with all devices. The tissue (muscle or liver) was cut by running the electrode over the surface at 200, 250 or 300 W, with the loop electrode used as the reference. After completing the procedure, the surgical wound and the surrounding tissue were dissected out and the depth of the heat-affected zone (HAZ, de®ned as the desiccated zone) measured. Results In pig muscle (stroke speed 5 mm/s) there was no signi®cant difference in the depth of the HAZ between the four VC electrodes and the loop, or among the VC electrodes at any of the power levels tested. In pig liver (stroke speed 5 mm/s), the roller cutting and Vapor Cut electrodes produced a thicker HAZ than the loop at all power levels tested (P<0.01). The Wedge electrode produced a signi®cantly thicker HAZ than the loop at 200 and 300 W (P<0.01). There were no signi®cant differences in HAZ among the VC electrodes at any power level. In dog muscle in vivo (stroke speed 10 mm/s), the roller cutting, Vapor Cut and Wedge electrodes produced a signi®cantly thicker HAZ at 250 W than the loop at 150 W (the usual power for TURP) (P<0.01). There was no signi®cant difference among the VC electrodes. In dog liver in vivo (stroke speed 10 mm/s), the roller cutting electrode produced a signi®cantly thicker HAZ at 250 W than the loop at 150 W (P<0.01). Conclusions The present VC electrodes produced a thicker desiccation zone at higher powers (200± 300 W) than the standard loop at the usual power (150 W). The four VC electrodes produced a similar desiccation zone. With pig muscle and liver in vitro, regular loops used at a higher power created a desiccation zone that was 70±80% of the depth created by the VC electrodes.
We present a case of spontaneous rupture of renal angiomyolipoma with a tumor thrombus extending from the right renal vein and inferior vena cava to the right atrium. A 41-year-old woman, previously in good health, was referred to our hospital with right flank pain. Computed tomography showed fat densities in both tumor and thrombus. Other imaging examinations also demonstrated a large right renal mass (18 cm in diameter), a long tumor thrombus (13 cm in length) and a small left renal tumor (1.5 cm in diameter). Right nephrectomy and en-bloc removal of the intra caval and intracardiac tumor thrombus were performed on cardiopulmonary bypass. It was pathologically diagnosed as an angiomyolipoma without tuberous sclerosis. At present, three years after surgery the patient is doing well, showing neither metastasis nor increase of the left renal angiomyolipoma. To our knowledge, our case seems to be the 3rd case report of renal angiomyolipoma with a tumor thrombus extending to the right atrium. We conclude that renal angiomyolipoma even with an intra cardiac tumor thrombus can be resected safely and successfully.
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