Eret Viktor, Hora Milan, Sykora Roman, Hes Ondrej, Urge Tomas, Klecka Jiri, Matejovic Martin
Department of Urology, Charles University Hospital, Plzen, Czech Republic.
Urology. 2009 May;73(5):1115-8. doi: 10.1016/j.urology.2008.03.011. Epub 2008 May 27.
To assess the feasibility of partial nephrectomy (PN) without renal hilar clamping using the 80-W GreenLight (532 nm) laser with opening of the collecting system followed by its suture in a porcine model.
We performed 12 open laser PNs in 6 farm pigs. We used the technique of incisional laser ablation of the lower pole of the right kidney. The pigs were kept alive, and 2 weeks later, underwent the same technique on the left kidney, followed by immediate killing. We recorded the acute and chronic outcomes. Renal parenchyma resection was achieved solely with the laser. The collecting system was opened with the laser in each procedure. All renal specimens underwent retrograde pyelography and histologic examination.
All procedures were completed without renal hilar clamping. The mean operative and laser time was 67.1 +/- 20.6 minutes (range 35-95) and 17.8 +/- 6.4 minutes (range 10-30), respectively. The mean resected kidney mass was 17% +/- 0.5% (range 10%-27%) of the total kidney mass. The mean blood loss was 142.5 +/- 88.9 mL (range 50-350). No evidence of urinary extravasation was seen after the acute procedures, but proven urinomas with decayed suture were found after all chronic procedures.
PN using the GreenLight laser is a feasible method for renal parenchyma incisional ablation. The laser hemostatic effect of interlobar vessel bleeding is safe and sufficient. The sutured collecting system after laser PN cannot heal in the thermically damaged tissue. The method is applicable to peripherally located lesions, without entering the collecting system. More prospective animal studies are necessary before application in humans.
在猪模型中评估使用80瓦绿激光（532纳米）在不阻断肾门的情况下进行部分肾切除术（PN）并打开集合系统后进行缝合的可行性。
我们在6头家猪身上进行了12例开放性激光PN。我们采用右侧肾下极切口激光消融技术。猪存活，2周后对左侧肾脏采用相同技术，随后立即处死。我们记录了急性和慢性结果。仅用激光实现肾实质切除。在每个手术过程中用激光打开集合系统。所有肾脏标本均进行逆行肾盂造影和组织学检查。
所有手术均在不阻断肾门的情况下完成。平均手术时间和激光时间分别为67.1±20.6分钟（范围35 - 95分钟）和17.8±6.4分钟（范围10 - 30分钟）。平均切除的肾脏质量为总肾脏质量的17%±0.5%（范围10% - 27%）。平均失血量为142.5±88.9毫升（范围50 - 350毫升）。急性手术后未见尿外渗迹象，但所有慢性手术后均发现经证实的尿囊肿伴缝线腐烂。
使用绿激光进行PN是肾实质切口消融的一种可行方法。叶间血管出血时激光止血效果安全且充分。激光PN后缝合的集合系统在热损伤组织中无法愈合。该方法适用于周边部位病变，无需进入集合系统。在应用于人类之前，需要更多的前瞻性动物研究。
