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

Abstract

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.

Could the heat sink effect of blood flow inside large vessels protect the vessel wall from thermal damage during RF‐assisted surgical resection?

“…its entire metallic length (L M in Figure 2(b)) with the blade inserted in the tissue, 2 the surgeon can also choose to first treat the 275 target tissue with the proximal part only (see Figure 1) to create a coagulation before placing the blade on the tissue. 34 In this case the contact surface is much smaller than in the case of total contact.…”

Radiofrequency pancreatic ablation and section of the main pancreatic duct does not lead to necrotizing pancreatitis

“…The pancreas of the experimental groups 0 to 3 was ablated and subsequently transected using the 3-mm version of the Coolinside® device (Apeiron Medical, Valencia, Spain). This device consists of a handheld instrument that performs a RF ablation with a cool-tip electrode of 20 mm length and permits section of the tissue with the built-in blade [11][12][13][14] . The pancreatic duct was not identified during the transection.…”

“…In recent years, our group has tested the ability of an internally cooled RF electrode to seal vessels in the liver 11,12 and in the kidney 13 . Preliminary studies using a porcine pancreatic model 14 suggested that distal pancreatic transection by such systems can adequately seal the main pancreatic duct easily and safely.…”

Long-term evolution of acinar-to-ductal metaplasia and β-cell mass after radiofrequency-assisted transection of the pancreas in a controlled large animal model

“…In recent years, our group has tested the ability of some RF electrodes to seal vessels in the liver [23,24] and kidney [25]. A recent study conducted on a porcine pancreatic model suggested that distal pancreatic transection by RF electrode can seal the main pancreatic duct easily and safely [22].…”