Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Abstract

Objective: The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT). Background data: LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results. Patients and methods: We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor £ 4 cm, predominant exophytic growth and intraparenchymal depth £ 1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. Results: We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma. Conclusions: Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found.

Thulium Laser‐Assisted Versus Conventional Laparoscopic Partial Nephrectomy for the Small Renal Mass

“…Another possible drawback of LLPN was the occurrence of unclassified resection margins and positive surgical margins in the histopathological examination, which was caused by impaired intraoperative visibility and coagulated and burned tissue . In our study, all patients could make a definitive diagnosis, with negative margins.…”

“…LLPN technique involves clamping the renal hilar vessels to minimize parenchymal bleeding during tumor excision. One major drawback during the LLPN using diode, holmium, or KTP lasers was the excessive smoke building due to the carbonization of the tissue; hemostasis was limited by smoke development and blood splashing onto the camera lens, which reduced visibility . In our study, excessive smoke can be avoided by slow saline irrigation and gas release using opened trocar.…”

“…The optimal NSS technique should allow precise and bloodless excision of tumors without clamping hilar vessels . During the past decade, laser‐assisted PN provided a bloodless tumor excision without renal artery clamping owing to the excellent coagulative and hemostatic properties of the lasers . Diode and thulium lasers were in the focus of research regarding laser‐assisted PN and displayed bright results .…”

“…During the past decade, laser‐assisted PN provided a bloodless tumor excision without renal artery clamping owing to the excellent coagulative and hemostatic properties of the lasers . Diode and thulium lasers were in the focus of research regarding laser‐assisted PN and displayed bright results . The 2‐μm continuous thulium laser does have excellent cutting and coagulation properties without causing blood splitting and with minimal smoke and minimal tissue charring .…”

Therapeutic use of lasers in urology

“…złotym standardem [4][5][6]. Opublikowano również prace dotyczące zastosowania lasera holmowego i diodowego w częściowej nefrektomii, należy jednak uznawać to wciąż za metodę eksperymentalną, której skuteczność wymaga potwierdzenia w dalszych badaniach [7][8][9].…”