Drerup Martin, Magdy Ahmed, Hager Martina, Colleselli Daniela, Kunit Thomas, Lusuardi Lukas, Janetschek Günter, Mitterberger Michael
Department of Urology, Paracelsus Medical University Salzburg, Muellner-Hauptstrasse 48, 5020, Salzburg, Austria.
Department of Pathology, Paracelsus Medical University Salzburg, Salzburg, Austria.
BMC Urol. 2018 Nov 9;18(1):99. doi: 10.1186/s12894-018-0405-9.
Warm ischemia (WI) and bleeding constitute the main challenges for surgeons during laparoscopic partial nephrectomy (LPN). Current literature on the use of lasers for cutting and coagulation remains scarce and with small cohorts. We present the largest case series to date of non-ischemic LPN using a diode laser for small exophytic renal tumors.
We retrospectively evaluated 29 patients with clinically localized exophytic renal tumors who underwent non-ischemic laser-assisted LPN with a 1318-nm wavelength diode laser. We started applying the laser 5 mm beyond the visible tumor margin, 5 mm away from the tissue in a non-contact fashion for coagulation and in direct contact with the parenchymal tissue for cutting. RESULTS: The renal vessels were not clamped, resulting in a WIT (warm ischaemic time) of 0 min, except for one case that required warm ischemia for 12 min and parenchymal sutures. No transfusion was needed, with a mean Hemoglobin drop of 1,4 mg/dl and no postoperative complications. The eGFR did not significantly change by 6 months. Histologically, the majority of lesions (n = 22/29) were renal-cell carcinoma stage pT1a. The majority of malignant lesions (n = 13/22) had a negative margin. However, margin interpretation was difficult in 9 cases due to charring of the tumor base. A mean follow-up of 1.8 years revealed no tumor recurrence. The mean tumor diameter was 19.4 mm.
The 1318-nm diode laser has the advantages of excellent cutting and sealing properties when applied to small vessels in the renal parenchyma, reducing the need for parenchymal sutures. However, excessive smoke, charring of the surgical margin, and inability to seal large blood vessels are encountered with this technique.
热缺血（WI）和出血是腹腔镜部分肾切除术（LPN）过程中外科医生面临的主要挑战。目前关于使用激光进行切割和凝血的文献仍然很少，且研究队列较小。我们展示了迄今为止使用二极管激光治疗小的外生性肾肿瘤的非缺血性LPN的最大病例系列。
我们回顾性评估了29例临床局限性外生性肾肿瘤患者，他们接受了使用1318纳米波长二极管激光的非缺血性激光辅助LPN。我们在可见肿瘤边缘外5毫米处开始应用激光，以非接触方式距组织5毫米进行凝血，并与实质组织直接接触进行切割。
除1例需要12分钟热缺血和实质缝合外，肾血管未被夹闭，热缺血时间（WIT）为0分钟。无需输血，血红蛋白平均下降1.4毫克/分升，无术后并发症。6个月时估算肾小球滤过率（eGFR）无显著变化。组织学上，大多数病变（n = 22/29）为pT1a期肾细胞癌。大多数恶性病变（n = 13/22）切缘阴性。然而，由于肿瘤基底碳化，9例病例的切缘判断困难。平均随访1.8年未发现肿瘤复发。肿瘤平均直径为19.4毫米。
1318纳米二极管激光应用于肾实质中的小血管时具有出色的切割和封闭性能，减少了实质缝合的需要。然而，该技术存在烟雾过多、手术切缘碳化以及无法封闭大血管的问题。
