Department of Urology, Columbia University Medical Center, New York, New York, USA.
J Endourol. 2012 Jun;26(6):592-6. doi: 10.1089/end.2010.0736. Epub 2011 Oct 19.
Laparoscopic partial nephrectomy (LPN) is the minimally invasive standard of care for the management of a cT(1a) renal mass. We evaluated a novel saline enhanced electrosurgical resection (SEER) device for performance of a nonischemic LPN.
Six pigs were used in a nonsurvival pilot study. Energy penetration was characterized by applying the SEER to the lower pole of each kidney for 30 seconds, 1 minute, and 3 minutes using pure cutting energy at 100W and a drip rate of 1 drip per second. Energy testing was performed with the hilum clamped in six kidneys and without clamping in six kidneys. Subsequently, a nonischemic upper pole LPN was performed with the SEER device, and the kidneys were harvested. The areas of necrosis were sectioned and stained with hematoxylin and eosin. Depth of necrosis was visualized grossly and microscopically for each time point. We also recorded time to perform LPN, estimated blood loss (EBL), and subjective severity of bleeding.
The average operative time was 15.4 minutes. The mean EBL was 44.2 mL with nine (75%) cases classified as minimal, 2 (17%) moderate, and 1 (8%) severe bleeding. The mean depth of necrosis on the kidney remnants was 2.97 mm. The mean depth of necrosis for unclamped kidneys at 30 seconds, 1 minute, and 3 minutes was 0.38 mm, 0.88 mm, and 1.27 mm, respectively. The mean depths for the clamped kidneys were 2.73 mm, 3.23 mm, and 8.68 mm respectively. Depth of necrosis was significantly higher in the clamped kidneys at 3 minutes (P=0.0035).
In the porcine model, the SEER transected parenchyma and collecting system with low resection times and minimal blood loss. Use of coagulation during resection is the main advantage of a monopolar resection compared with cold scissors. Testing performed for 3 minutes during hilar clamping demonstrated a significantly deeper level of necrosis.
腹腔镜部分肾切除术（LPN）是治疗 cT(1a) 肾肿瘤的微创标准治疗方法。我们评估了一种新型盐水增强电外科切除术（SEER）设备，用于进行非缺血性 LPN。
6 头猪用于非生存性初步研究。采用 SEER 在 30 秒、1 分钟和 3 分钟内以 100W 的纯切割能量和 1 滴/秒的滴注率应用于每个肾脏的下极，以评估能量穿透情况。在 6 个肾脏中夹闭肾门和不夹闭肾门的情况下进行能量测试。随后，使用 SEER 设备进行非缺血性上极 LPN，并收获肾脏。坏死区域被切片并用苏木精和伊红染色。对每个时间点的坏死深度进行大体和显微镜下观察。我们还记录了进行 LPN 的时间、估计失血量（EBL）和出血的主观严重程度。
平均手术时间为 15.4 分钟。平均 EBL 为 44.2mL，9 例（75%）为轻度、2 例（17%）为中度和 1 例（8%）为重度出血。肾残端坏死的平均深度为 2.97mm。未夹闭肾门时，30 秒、1 分钟和 3 分钟的平均坏死深度分别为 0.38mm、0.88mm 和 1.27mm。夹闭肾门时的平均深度分别为 2.73mm、3.23mm 和 8.68mm。夹闭肾门 3 分钟时的坏死深度明显更高（P=0.0035）。
在猪模型中，SEER 在 3 分钟时可明显降低缺血风险，且具有较低的切除时间和最小的失血量。与冷剪刀相比，使用单极切割时的主要优势在于切割时可以止血。在肾门夹闭期间进行 3 分钟的测试表明，坏死程度明显更深。
