Single instrument for hemostatic control in laparoscopic partial nephrectomy in a porcine model without renal vascular clamping.

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.