Moinzadeh Alireza, Gill Inderbir S, Rubenstein Mauricio, Ukimura Osamu, Aron Monish, Spaliviero Massimiliano, Nahen Kester, Finelli Antonio, Magi-Galluzzi Cristina, Desai Mihir, Kaouk Jihad, Ulchaker James C
Section of Laparoscopic and Robotic Surgery, Glickman Urological Institute, and Department of Anatomic Pathology, Cleveland Clinic Foundation, Cleveland, Ohio 44195, USA.
J Urol. 2005 Sep;174(3):1110-4. doi: 10.1097/01.ju.0000168620.36893.6c.
Laparoscopic partial nephrectomy (LPN) with hilar clamping represents the various challenges associated with warm ischemia. We tested the feasibility, and acute and chronic outcomes of LPN using a potassium-titanyl-phosphate (KTP) laser without vascular hilar clamping in the survival calf model.
Six Jersey calves weighing 76 to 94 kg underwent a total of 12 staged bilateral transperitoneal laser LPNs of the mid/lower pole using an 80 W KTP laser, including left kidney chronic LPN with 1-month followup in 6 and right kidney acute LPN with immediate sacrifice in 6. Two techniques (ablative vaporization in 5 subjects and wedge resection in 7) were evaluated. Renal parenchymal resection and hemostasis were achieved only with the laser without any adjunctive hemostatic sutures or bioadhesives. Retrograde pyelography, renal arteriography and histological analyses were performed.
All 12 procedures were successful performed laparoscopically without open conversion and 11 (92%) were done without hilar clamping. Mean total operative time was 2.9 hours (range 1.5 to 5) and mean blood loss was 119 cc (range 25 to 300). Mean lasing time was 56 minutes (range 20 to 100) with an average energy use of 54 kJ. Mean preoperative and postoperative hemoglobin (10.38 and 10.52 gm/dl) and serum creatinine (0.46 and 0.4 gm/dl, respectively) were similar. At 1-month followup there was no evidence of urinary leakage or arteriovenous fistula.
This initial study of laparoscopic KTP laser partial nephrectomy without hilar clamping confirms its technical feasibility in most cases and good short-term outcomes. This success of laser LPN in the robust survival calf model with its human-sized kidney holds promise for future clinical application.
采用肾门阻断的腹腔镜部分肾切除术（LPN）面临与热缺血相关的各种挑战。我们在存活小牛模型中测试了使用磷酸钛钾（KTP）激光且不进行肾门血管阻断的LPN的可行性、急性和慢性结果。
6头体重76至94千克的泽西小牛接受了总共12次分期双侧经腹激光LPN，使用80W KTP激光对中/下极进行手术，其中6头进行左肾慢性LPN并随访1个月，6头进行右肾急性LPN并立即处死。评估了两种技术（5例采用消融汽化，7例采用楔形切除术）。仅使用激光实现肾实质切除和止血，未使用任何辅助止血缝线或生物粘合剂。进行了逆行肾盂造影、肾动脉造影和组织学分析。
所有12例手术均成功通过腹腔镜完成，未中转开放手术，11例（92%）未进行肾门阻断。平均总手术时间为2.9小时（范围1.5至5小时），平均失血量为119毫升（范围25至300毫升）。平均激光照射时间为56分钟（范围20至100分钟），平均能量使用为54千焦。术前和术后平均血红蛋白（分别为10.38和10.52克/分升）及血清肌酐（分别为0.46和0.4克/分升）相似。随访1个月时，未发现尿漏或动静脉瘘迹象。
这项关于不进行肾门阻断的腹腔镜KTP激光部分肾切除术的初步研究证实了其在大多数情况下的技术可行性和良好的短期结果。激光LPN在具有人类大小肾脏的健壮存活小牛模型中的成功为未来临床应用带来了希望。
