Design and simulation of novel laparoscopic renal denervation system: a feasibility study

Ye, Eunbi; Baik, Jinhwan; Lee, Seunghyun; Ryu, Seon Young; Yang, Sun-Choel; Choi, Eue Keun; Song, Won Hoon; Yuk, Hyeong Dong; Jeong, Chang Wook; Park, Sung Min

doi:10.1080/02656736.2018.1468037

Cited by 11 publications

(18 citation statements)

References 30 publications

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“…They evaluated the thermal effectiveness via simulation study on a numerical model designed using histological data and validated the results by the in vitro study. Finally, the simulation results showed that new device is safer and more effective than the existing catheter-based systems [18]. These studies show that RDN from renal artery adventitia pathway is feasible in the treatment of hypertension, which also supports our results.…”

Section: Discussionsupporting

confidence: 86%

Laparoscopic based renal denervation in a canine neurogenic hypertension model

Shao

Zhou

You

et al. 2020

BMC Cardiovasc Disord

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Background: Previous renal denervation (RDN) studies showed controversial results in reducing blood pressure. The aim of this study was to provide evidence supporting the effectiveness of laparoscopic-based renal denervation (L-RDN) in treating hypertension. Methods: Sixteen Beagle dogs were randomly divided into RDN group (n = 12) and sham group (n = 4). Neurogenic hypertension was generated in all dogs via carotid artery route. L-RDN was performed in the RDN group, with sham operation performed as a control. Blood pressure (BP) changes were recorded at 2, 4, 6, and 8 weeks after the procedure. Changes in serum creatinine (sCr), blood urea nitrogen (BUN) and level of norepinephrine (NE) were analyzed. Histological changes of kidney and renal arteries were also evaluated. Results: BP and NE levels were significantly elevated after hypertension induction (p < 0.01). Systolic and diastolic BP of RDN group were decreased by 15.5 mmHg and 7.3 mmHg (p < 0.0001 and p = 0.0021, respectively) at the eighth week after L-RDN. Invasive systolic and diastolic BP of RDN group were significantly decreased by 14.5 mmHg and 15.3 mmHg (p < 0.0001). In contrast, there was no significant decrease in blood pressure in the sham group. In addition, RDN group but not the sham group showed a significant decrease in NE levels (p < 0.001), while no significant changes in sCr and BUN were observed in both groups. Pathological examinations showed no discernible damage, tear, or dissection to the renal arteries in RND group. Conclusions: L-RDN lowered BP and NE levels in hypertensive dogs without affecting renal artery morphology and kidney function.

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Section: Discussionsupporting

confidence: 86%

Laparoscopic based renal denervation in a canine neurogenic hypertension model

Shao

Zhou

You

et al. 2020

BMC Cardiovasc Disord

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“…In in-vivo simulation, the artery 3D, as shown in Fig. 5 was designed based on previous histological studies where the diameter of the artery, the diameter of the lumen, and thickness of the artery wall were 5 mm, 2mm, and 1.5 mm, respectively [17,21]. The arterial wall was composed of tunica media and adventitia.…”

Section: E = −∇V (3)mentioning

confidence: 99%

“…While it cannot be generalized, the lesion depth for the catheter-based RDN was found to be about 2 mm for a cadaver [16] and 6 mm for animal models [17][18][19] from multiple studies, but 31% of renal nerves are located 2-10 mm away from the endoluminal surface [20,21]. Thus, it cannot completely ablate renal sympathetic nerves outside the arterial wall.…”

Section: Introductionmentioning

confidence: 99%

“…The system should also be safe, operator-independent, and achieve complete denervation. As explained in our previous simulation study, our hypothesis was that the solution to satisfy these unmet needs could be found in a laparoscopic approach [17]. The laparoscopic RDN provides more effective denervation compared to the catheter-based RDN and is independent of anatomical variation in the renal artery and nerve distribution.…”

Section: Introductionmentioning

confidence: 99%

“…The laparoscopic RDN provides more effective denervation compared to the catheter-based RDN and is independent of anatomical variation in the renal artery and nerve distribution. It also achieves the denervation without injuring the artery [17] and its adjacent organs. Even though the proposed laparoscopy-based technique is more invasive compared to catheter-based RDN, it enhances the safety against thermal damage to the artery and the nerve denervation is more effective than the catheter-based approach.…”

Section: Introductionmentioning

confidence: 99%

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Laparoscopic Renal Denervation System for Treating Resistant Hypertension: Overcoming Limitations of Catheter-Based Approaches

Baik

Song

Yim

et al. 2020

IEEE Trans. Biomed. Eng.

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In a pivotal clinical trial, the percutaneous catheter-based renal denervation system developed to treat resistant hypertension did not show effectiveness in reducing blood pressure because of its fundamental limitation to ablate deeper nerves present around the renal artery. Methods: We propose a new renal denervation strategy called laparoscopic denervation system (LDS) based-on laparoscopy procedure to ablate the renal nerves completely but inhibit the thermal arterial damage. The system has flexible electrodes to bend around the arterial wall to ablate nerves The simulation study using validated in-silico models evaluated the heat distribution on the outer arterial wall, and an acute animal study (swine model) was conducted to demonstrate the feasibility of LDS in vivo. Results: The simulation study confirmed that LDS could localize the heat distribution between the electrode and the outer arterial wall. In the animal study, we could maximize nerve denervation by the localizing ablation energy within the renal nerves and achieve nerve denaturation and decrease in neural density by 20.78 % (P<0.001), while maintaining a constant tip temperature of 65 ℃ for the duration of 70 s treatment. The study confirmed intact lumen artery through histological analysis and acute reduction in systolic blood pressure by 9.55 mmHg (p<0.001) Conclusion: The LDS presented here has potential to effectively and safely ablate the renal nerves, independent of anatomical variation and nerve distribution, to control hypertension in real clinical conditions. Significance: LDS approach is innovative, inventive, and presents a novel technique to treat hypertension.

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Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

Wang

Zhao

et al. 2022

Int Urol Nephrol

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Purpose To investigate whether extensive renal artery isolation during robotic-assisted partial nephrectomy (RAPN) for renal cell carcinoma (RCC) affects blood pressure (BP) of patients with poorly controlled hypertension. Methods We included 60 patients diagnosed with poorly controlled hypertension who underwent RAPN by an experienced surgeon. The renal artery of the treated kidney was sufficiently isolated. Systolic BP (SBP), diastolic BP (DBP) and antihypertensive medication information were obtained at baseline and 3- and 6-month follow-up after surgery. Primary endpoints were changes in BP, and medications. Predictors of SBP reduction at 3 months were assessed by multivariable logistic regression. Results All 60 RAPN procedures were successful, with no major intra- or postoperative complications. Mean SBP and DBP decreased significantly at 3 months after surgery (SBP, −7.8 ± 6.3 mmHg, P < 0.001; DBP, −4.2 ± 6.4 mmHg, P = 0.01). SBP and DBP did not differ between 3- and 6-month follow-up. The mean number of BP medications prescribed was lower at 3 months than baseline (1.7 ± 1.0 vs 2.1 ± 1.0, P = 0.016). The only significant predictor of SBP reduction at 3 months was baseline SBP. Conclusions Renal denervation with extensive renal artery isolation during RAPN may improve BP control among patients with poorly controlled hypertension in short term.

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Design and simulation of novel laparoscopic renal denervation system: a feasibility study

Cited by 11 publications

References 30 publications

Laparoscopic based renal denervation in a canine neurogenic hypertension model

Laparoscopic based renal denervation in a canine neurogenic hypertension model

Laparoscopic Renal Denervation System for Treating Resistant Hypertension: Overcoming Limitations of Catheter-Based Approaches

Effect of extensive artery isolation during robotic-assisted partial nephrectomy on blood pressure of patients with poorly controlled hypertension: a preliminary study

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