Department of Urology, Hospital Clínico Universitario Lozano Blesa, Zaragoza, Spain.
J Endourol. 2011 Jun;25(6):1005-11. doi: 10.1089/end.2010.0557. Epub 2011 May 19.
To test the viability of a new device to obtain hemostasis during laparoscopic partial nephrectomy (LPN) without vascular clamping.
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.
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).
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.
测试一种新设备在腹腔镜部分肾切除术（LPN）中实现止血而无需血管夹闭的可行性，该设备通过射频（RF）辅助，无需夹持肾蒂即可同时进行凝血和切割操作。
我们进行了一项新设备与标准技术的对比实验研究，前者为一种手持式仪器，包含同时进行凝血和切割任务的功能，无需夹持肾蒂；后者为标准技术，采用夹持肾蒂的方法。该实验使用了猪模型（每组 10 只动物），存活时间为 17 天。
与标准技术相比，新设备的估计失血量明显更低（15.5±23.7 与 79.4±76.3 mL）。虽然新设备的切割时间更长（10.7±13.7 与 2.1±1.2 min），但总手术时间明显更短（35.3±13.7 与 60.2±10.5 min）。两组均出现 5 例局部尿外渗（尿囊肿）。然而，在用亚甲蓝试验检测后，使用新设备的组中，漏尿的病例数明显更多：8 例（80%）与仅 1 例（11%），使用标准技术。新设备的组织坏死深度明显更深（6.6±0.9 与 <1 mm）。
实验结果表明，所提出的 RF 辅助设备在不使用额外器械或手术操作的情况下，可在肾实质切割过程中提供充分的止血控制，因此可能成为无血管夹闭的 LPN 的一种有价值的辅助手段。该设备在有效密封集合系统方面效果不佳。
