Kamiyama Yoshihiro, Yamashita Shinichi, Nakagawa Atsuhiro, Fujii Shinji, Mitsuzuka Koji, Kaiho Yasuhiro, Ito Akihiro, Abe Takaaki, Tominaga Teiji, Arai Yoichi
Department of Urology, Tohoku University Graduate School of Medicine.
Department of Neurosurgery, Tohoku University Graduate School of Medicine.
Tohoku J Exp Med. 2017 Sep;243(1):57-65. doi: 10.1620/tjem.243.57.
In the setting of partial nephrectomy (PN) for renal cell carcinoma, postoperative renal dysfunction might be caused by surgical procedure. The aim of this study was to clarify the technical safety and renal damage after off-clamp laparoscopic PN (LPN) with a piezo actuator-driven pulsed water jet (ADPJ) system. Eight swine underwent off-clamp LPN with this surgical device, while off-clamp open PN was also performed with radio knife or soft coagulation. The length of the removed kidney was 40 mm, and the renal parenchyma was dissected until the renal calyx became clearly visible. The degree of renal degeneration from the resection surface was compared by Hematoxylin-Eosin staining and immunostaining for 1-methyladenosine, a sensitive marker for the ischemic tissue damage. The mRNA levels of neutrophil gelatinase-associated lipocalin (Ngal), a biomarker for acute kidney injury, were measured by quantitative real-time PCR. Off-clamp LPN with ADPJ system was successfully performed while preserving fine blood vessels and the renal calix with little bleeding. In contrast to other devices, the resection surface obtained with the ADPJ system showed only marginal degree of ischemic changes. Indeed, the expression level of Ngal mRNA was lower in the resection surface obtained with the ADPJ system than that with soft coagulation (p = 0.02). Furthermore, using the excised specimens of renal cell carcinoma, we measured the breaking strength at each site of the human kidney, suggesting the applicability of this ADPJ to clinical trials. In conclusion, off-clamp LPN with the ADPJ system could be safely performed with attenuated renal damage.
在对肾细胞癌进行部分肾切除术（PN）的情况下，术后肾功能障碍可能由手术操作引起。本研究的目的是阐明使用压电致动器驱动的脉冲水刀（ADPJ）系统进行非阻断性腹腔镜部分肾切除术（LPN）后的技术安全性和肾脏损伤情况。八头猪接受了使用该手术设备的非阻断性LPN，同时也使用射频刀或软凝技术进行了非阻断性开放性PN。切除的肾脏长度为40毫米，肾实质被解剖直至肾盏清晰可见。通过苏木精-伊红染色和对1-甲基腺苷（一种缺血性组织损伤的敏感标志物）的免疫染色，比较切除表面的肾脏变性程度。通过定量实时PCR测量中性粒细胞明胶酶相关脂质运载蛋白（Ngal，一种急性肾损伤的生物标志物）的mRNA水平。使用ADPJ系统成功进行了非阻断性LPN，同时保留了细小血管和肾盏，出血很少。与其他设备相比，ADPJ系统获得的切除表面仅显示出轻微的缺血性变化。事实上，ADPJ系统获得的切除表面的Ngal mRNA表达水平低于软凝技术获得的切除表面（p = 0.02）。此外，使用肾细胞癌的切除标本，我们测量了人肾脏每个部位的断裂强度，表明这种ADPJ可应用于临床试验。总之，使用ADPJ系统进行非阻断性LPN可以安全地进行，同时减轻肾脏损伤。
