Energy sources for laparoscopic partial nephrectomy: critical appraisal

Rubinstein, Mauricio; Moinzadeh, Alireza; Colombo, José R.; Favorito, Luciano A.; Sampaio, Francisco J.B.; Gill, Inderbir S.

doi:10.1590/s1677-55382007000100002

Cited by 7 publications

(6 citation statements)

References 45 publications

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“…The main limitation of RFA is the challenge of performing centrally located tumor excisions, which carries a high risk of collecting-system injury. 15 Treatment for small renal tumors has been evolving from radical nephrectomy to nephron-sparing techniques, including ablation. 16,17 Although cryotherapy and RFA are increasingly being applied clinically, there is a need for further research in this field.…”

Section: Introduction Tmentioning

confidence: 99%

Proportional Analysis of Pig Kidney Arterial Segments: Differences from the Human Kidney

Pereira‐Sampaio

Favorito

Henry

et al. 2007

Journal of Endourology

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Purpose: To present a systematic study and a proportional analysis of the arterial segments of the pig kidney.Materials and Methods: Sixty-one three-dimensional endocasts of the arterial segments of pig kidneys were studied. Each segment was injected with a resin of a different color. Cavalieri's principle was used to calculate the volume of each renal segment, and these results were compared with the results from the point-counting planimetry method used on photographs of pig-kidney surfaces.Results: Two to five renal segments were observed. Division into two segments, a cranial and a caudal, was the most common (42.62%). The renal volume ranged from 101 to 173 cm 3 (mean 130.85 cm 3 ). The cranial segment was present in 39 of the 57 casts (68.42%). It presented the greatest median value of proportional area (50.00%) and also the greatest maximum value of proportional area, accounting for as much as 74.04% of the total kidney area. The ventral segment, which was found in 20 of the 57 casts (35.09%), presented the lowest median value of proportional area (13.87%) and showed the most variation in area (coefficient of variation 72.89%). There was no significant statistical difference between the segmental areas as evaluated by Cavalieri's principle and by the point-counting planimetry method.Conclusions: The distribution and size of the renal-arterial segments in pigs are not similar to those of the human kidneys. Therefore, this information must be taken into account by practitioners of urologic training or ablation using pigs as the animal model, as the structure of the porcine arterial segments cannot be transposed to humans.

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Section: Introduction Tmentioning

confidence: 99%

Proportional Analysis of Pig Kidney Arterial Segments: Differences from the Human Kidney

Pereira‐Sampaio

Favorito

Henry

et al. 2007

Journal of Endourology

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“…Several hemostatic modalities have been used during LPN with variable success, including argon beam coagulation, neodymium: yttrium-aluminum-garnet (YAG) laser, holmium:YAG laser, Harmonic Scalpel, hand assistance, bipolar electrical current, unipolar spray electrical current, ultrasound scissors, microwave tissue coagulation, cable ties, radiofrequency ablation, and the variable hemostatic sealants. 15,16 When LPN is performed without controlling the renal vessels, the above mentioned hemostatic modalities are used for dissecting the parenchyma. There are inherent limitations, however, such as charring of the tissue, that interfere with the determination of margin status during resection and the assessment of the integrity of the collecting system.…”

Section: Discussionmentioning

confidence: 99%

“…There are inherent limitations, however, such as charring of the tissue, that interfere with the determination of margin status during resection and the assessment of the integrity of the collecting system. 15,16 In addition, deep coagulation may lead to delayed avascular necrosis. These limitations potentially result in positive surgical margin, delayed bleeding, and urinary fistula formation.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy without Hilar Control

Jeon

Kim

2008

Journal of Endourology

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“…Although other handheld RF-assisted devices, such as TissueLink, are able to stem bleeding of 1 to 2 mm vessels 2 and even 3 mm, 19 the process is more time-consuming than vessel precoagulation. 2 In addition, TissueLink is not usually able to control large bleeding points, such as openings in the trunks of the hepatic vein, 21 which the new device has proved it can do.…”

Section: Ri´os Et Almentioning

confidence: 99%

Single Instrument for Hemostatic Control in Laparoscopic Partial Nephrectomy in a Porcine Model Without Renal Vascular Clamping

Ríos

Zalabardo²,

Burdı́o³

et al. 2011

Journal of Endourology

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Purpose: To test the viability of a new device to obtain hemostasis during laparoscopic partial nephrectomy (LPN) without vascular clamping. Materials and Methods: We performed a comparative experimental study between a new radiofrequency (RF)-assisted device consisting of a handheld instrument that simultaneously conducts coagulation and cutting tasks without hilar clamping vs a standard technique with hilar clamping. A porcine model was used (10 animals per group) with survival of 17 days. Results: The estimated blood loss with the new device was significantly lower than with the standard technique (15.5 -23.7 vs 79.4 -76.3 mL). Although transection time was longer with the new device (10.7 -13.7 vs 2.1 -1.2 min), the total operative time was significantly shorter (35.3 -13.7 vs 60.2 -10.5 min). Evidence of localized urinary extravasation (urinoma) was identical in both groups (five cases). The group subjected to the new device, however, showed a significantly higher number of cases of leakage after conducting the methylene-blue test: eight (80%) cases vs only one (11%) with the standard technique. Necrosis depth was significantly greater with the new device (6.6 -0.9 vs < 1 mm). Conclusions:The experimental results suggest that the proposed RF-assisted device provides adequate hemostatic control during transection of the renal parenchyma without additional instruments or surgical maneuvers and could therefore be a valuable adjunct for LPN without vascular clamping. The device was unsuccessful in effectively sealing the collecting system.

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Energy sources for laparoscopic partial nephrectomy: critical appraisal

Cited by 7 publications

References 45 publications

Proportional Analysis of Pig Kidney Arterial Segments: Differences from the Human Kidney

Proportional Analysis of Pig Kidney Arterial Segments: Differences from the Human Kidney

Laparoscopic Partial Nephrectomy without Hilar Control

Single Instrument for Hemostatic Control in Laparoscopic Partial Nephrectomy in a Porcine Model Without Renal Vascular Clamping

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