Zero Ischemia Laparoscopic Partial Thulium Laser Nephrectomy

Thomas, Arun Z.; Smyth, Laura Dimmit; Hennessey, Derek; O’Kelly, Fardod; Moran, Dermot; Lynch, Thomas

doi:10.1089/end.2012.0527

Cited by 31 publications

(20 citation statements)

References 18 publications

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“…The median blood loss in our cohort was 250 ml, which is comparable to recent reports on open or laparoscopic laser-driven approaches under zero ischemia [13,14]. There was only one case of solitary kidney tumor with focally positive surgical margin in a patient with high PADUA score of 13.…”

Section: Discussionsupporting

confidence: 81%

Partial nephrectomy driven by cavitron ultrasonic surgical aspirator under zero ischemia: a pilot study

2015

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Section: Discussionsupporting

confidence: 81%

Partial nephrectomy driven by cavitron ultrasonic surgical aspirator under zero ischemia: a pilot study

2015

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“…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 .…”

Section: Introductionmentioning

confidence: 99%

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

Wang

Shao

2019

Lasers Surg Med

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Background and Objectives Laparoscopic partial nephrectomy (LPN) has gained acceptance as a minimally invasive treatment option for small renal masses (SRMs). Laser‐assisted LPN (LLPN) provided a bloodless tumor excision without renal artery clamping owing to the excellent coagulative and hemostatic properties of the lasers. The primary aim of this study is to evaluate the technical feasibility and outcomes of 2‐μm continuous thulium LLPN and conventional LPN (CLPN) in the treatment of patients with SRMs. Study Design/Materials and Methods A retrospective analysis was performed for the medical charts of 312 patients with SRMs who underwent minimally invasive nephron‐sparing surgery in our institution between January 2013 and December 2017. All 36 LLPN patients were matched with 36 CLPN patients. Surgical data, complications, pathological variables, oncological, functional, and health‐related quality of life (HRQoL) outcomes were reviewed. Results The two groups were similar in demographic characteristics. The renal vessels were not clamped in the LLPN group. Compared with the CLPN group, patients in the LLPN group had shorter warm ischemia time (WIT) (0 vs. 12.4 minutes, P = 0.000), longer tumor resection time (9.5 vs. 2.2 minutes; P = 0.000), and decreased operative time (84.1 vs. 95.5 minutes, p = 0.029). There were no open conversions and no transfusion in both groups. Median follow‐ups for LLPN and CLPN were 56.2 and 48.6 months, respectively. The complication rate, renal functional outcomes, local recurrence rates, recurrence‐free survival rates, and SF‐36 questionnaire score were similar between the two groups. Conclusions Although this matched pair study showed CLPN had a longer WIT and higher operative time, the oncological and functional outcomes of LLPN and CLPN were similar. Both LLPN and CLPN are viable treatment options for select patients with SRMs. Lasers Surg Med. © 2019 Wiley Periodicals, Inc.

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“…7 LPN is a technically challenging procedure, mainly because of the lack of reliable methods of hemostasis and requiring prolonged WIT 14 To date, 12 research groups have published small series concerning clinically tested laser-assisted open or laparoscopic partial nephrectomies. 11,[15][16][17][18][19][20][21][22][23][24][25] To our knowledge, this is largest published series of laser-assisted laparoscopic partial nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Knezevic

Kuliš

Maric

et al. 2014

Photomedicine and Laser Surgery

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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.

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Zero Ischemia Laparoscopic Partial Thulium Laser Nephrectomy

Cited by 31 publications

References 18 publications

Partial nephrectomy driven by cavitron ultrasonic surgical aspirator under zero ischemia: a pilot study

Partial nephrectomy driven by cavitron ultrasonic surgical aspirator under zero ischemia: a pilot study

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

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

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