Zhang Xiang-Min, Xu Ji-Dong, Lv Jian-Min, Pan Xiu-Wu, Cao Jian-Wei, Chu Jian, Cui Xin-Gang
Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China.
Department of Urology, Gongli Hospital of The Second Military Medical University, Shanghai 200135, China.
World J Clin Cases. 2022 Jun 16;10(17):5646-5654. doi: 10.12998/wjcc.v10.i17.5646.
Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment. The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.
To present the first series of laparoscopic partial nephrectomy (LPN) by GreenLight laser enucleation without renal artery clamping. Due to the excellent coagulation and hemostatic properties of the laser, laser-assisted LPN (LLPN) makes it possible to perform a "zero ischemia" resection.
Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed. All clinical information, surgical and post-operative data, complications, pathological and functional outcomes were analyzed.
Surgery was successfully completed in all patients, and no open or radical nephrectomy was performed. The renal artery was not clamped, leading to no ischemic time. No blood transfusions were required, the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred. The mean operation time was 104.3 ± 8.2 min. The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d, and the mean postoperative hospital stay was 6.5 ± 0.7 d. No serious complications occurred. Postoperative pathological results showed clear cell carcinoma in 12 patients, papillary renal cell carcinoma in 2 patients, and hamartoma in 1 patient. The mean creatinine level was 75.0 ± 0.8 μmol/L (range 61.0-90.4 μmol/L) at 1 mo after surgery, and there were no statistically significant differences compared with pre-operation ( > 0.05). The glomerular filtration rate ranged from 45.1 to 60.8 mL/min, with an average of 54.0 ± 5.0 mL/min, and these levels were not significantly different from those before surgery ( > 0.05).
GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors (exogenous tumors of stage T1a) during LPN. However, use of this technique can lead to the generation of excessive smoke.
腹腔镜部分肾切除术已广泛应用于肾细胞癌的治疗。绿激光在腹腔镜部分肾切除术中的疗效尚不清楚。
介绍首例不阻断肾动脉的绿激光剜除术腹腔镜部分肾切除术（LPN）。由于激光具有出色的凝血和止血特性，激光辅助LPN（LLPN）使“零缺血”切除成为可能。
回顾性分析我院15例接受高功率绿激光非缺血性LPN治疗的T1a期外生性肾肿瘤患者。分析所有临床信息、手术及术后数据、并发症、病理及功能结果。
所有患者手术均成功完成，未行开放或根治性肾切除术。未阻断肾动脉，无缺血时间。无需输血，平均血红蛋白水平为96.0至132.0 g/L，未发生术后并发症。平均手术时间为104.3±8.2分钟。术后负压引流拔除时间为5.0至7.0天，平均术后住院时间为6.5±0.7天。未发生严重并发症。术后病理结果显示，12例为透明细胞癌，2例为乳头状肾细胞癌，1例为错构瘤。术后1个月时平均肌酐水平为75.0±0.8μmol/L（范围61.0 - 90.4μmol/L），与术前相比无统计学显著差异（>0.05）。肾小球滤过率范围为45.1至60.8 mL/min，平均为54.0±5.0 mL/min，与术前水平无显著差异（>0.05）。
绿激光用于LPN治疗小肾肿瘤（T1a期外生性肿瘤）时具有非凡的切割和封闭优势。然而，使用该技术可能会产生过多烟雾。
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