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Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Identifieur interne : 000130 ( Pmc/Checkpoint ); précédent : 000129; suivant : 000131

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Auteurs : Nikola Knezevic ; Tomislav Kulis ; Marjan Maric ; Marija Topalovic Grkovic ; Ivan Krhen ; Zeljko Kastelan

Source :

RBID : PMC:3926155

Abstract

Abstract

Objective: The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT). Background data: LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results. Patients and methods: We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor ≤4 cm, predominant exophytic growth and intraparenchymal depth ≤1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. Results: We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma. Conclusions: Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found.


Url:
DOI: 10.1089/pho.2013.3646
PubMed: 24460067
PubMed Central: 3926155


Affiliations:


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PMC:3926155

Le document en format XML

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<title xml:lang="en">Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique</title>
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<name sortKey="Knezevic, Nikola" sort="Knezevic, Nikola" uniqKey="Knezevic N" first="Nikola" last="Knezevic">Nikola Knezevic</name>
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<name sortKey="Kulis, Tomislav" sort="Kulis, Tomislav" uniqKey="Kulis T" first="Tomislav" last="Kulis">Tomislav Kulis</name>
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<name sortKey="Maric, Marjan" sort="Maric, Marjan" uniqKey="Maric M" first="Marjan" last="Maric">Marjan Maric</name>
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<author>
<name sortKey="Grkovic, Marija Topalovic" sort="Grkovic, Marija Topalovic" uniqKey="Grkovic M" first="Marija Topalovic" last="Grkovic">Marija Topalovic Grkovic</name>
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<name sortKey="Krhen, Ivan" sort="Krhen, Ivan" uniqKey="Krhen I" first="Ivan" last="Krhen">Ivan Krhen</name>
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<name sortKey="Kastelan, Zeljko" sort="Kastelan, Zeljko" uniqKey="Kastelan Z" first="Zeljko" last="Kastelan">Zeljko Kastelan</name>
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<name sortKey="Grkovic, Marija Topalovic" sort="Grkovic, Marija Topalovic" uniqKey="Grkovic M" first="Marija Topalovic" last="Grkovic">Marija Topalovic Grkovic</name>
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<name sortKey="Krhen, Ivan" sort="Krhen, Ivan" uniqKey="Krhen I" first="Ivan" last="Krhen">Ivan Krhen</name>
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<title level="j">Photomedicine and Laser Surgery</title>
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<title>Abstract</title>
<p>
<bold>
<italic>Objective:</italic>
</bold>
The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT).
<bold>
<italic>Background data:</italic>
</bold>
LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results.
<bold>
<italic>Patients and methods:</italic>
</bold>
We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor ≤4 cm, predominant exophytic growth and intraparenchymal depth ≤1.5 cm, with a minimum distance of 5 mm from the urinary collecting system.
<bold>
<italic>Results:</italic>
</bold>
We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma.
<bold>
<italic>Conclusions:</italic>
</bold>
Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found.</p>
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<journal-id journal-id-type="nlm-ta">Photomed Laser Surg</journal-id>
<journal-id journal-id-type="iso-abbrev">Photomed Laser Surg</journal-id>
<journal-id journal-id-type="publisher-id">pho</journal-id>
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<journal-title>Photomedicine and Laser Surgery</journal-title>
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<publisher-name>Mary Ann Liebert, Inc.</publisher-name>
<publisher-loc>140 Huguenot Street, 3rd FloorNew Rochelle, NY 10801USA</publisher-loc>
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<article-title>Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique</article-title>
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<contrib-group>
<contrib contrib-type="author">
<name>
<surname>Knezevic</surname>
<given-names>Nikola</given-names>
</name>
<degrees>MD, PhD</degrees>
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<contrib contrib-type="author" corresp="yes">
<name>
<surname>Kulis</surname>
<given-names>Tomislav</given-names>
</name>
<degrees>MD, PhD</degrees>
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<contrib contrib-type="author">
<name>
<surname>Maric</surname>
<given-names>Marjan</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Grkovic</surname>
<given-names>Marija Topalovic</given-names>
</name>
<degrees>MD</degrees>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Krhen</surname>
<given-names>Ivan</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<contrib contrib-type="author">
<name>
<surname>Kastelan</surname>
<given-names>Zeljko</given-names>
</name>
<degrees>MD, PhD</degrees>
</contrib>
<aff id="aff1">Department of Urology, University Hospital Center Zagreb,
<institution>University of Zagreb School of Medicine</institution>
, Zagreb,
<country>Croatia</country>
.</aff>
</contrib-group>
<author-notes>
<corresp>
<addr-line>Address correspondence to:</addr-line>
<addr-line>
<italic>Tomislav Kulis</italic>
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<addr-line>
<italic>Department of Urology</italic>
</addr-line>
<institution>
<italic>University Hospital Center Zagreb</italic>
</institution>
<addr-line>
<italic>Kispaticeva 12</italic>
</addr-line>
<addr-line>
<italic>10000 Zagreb</italic>
</addr-line>
<country>Croatia</country>
<break></break>
<italic>E-mail:</italic>
<email xlink:href="mailto:tkulis@gmail.com">tkulis@gmail.com</email>
</corresp>
</author-notes>
<pub-date pub-type="ppub">
<day>01</day>
<month>2</month>
<year>2014</year>
<pmc-comment>string-date: February 2014</pmc-comment>
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<volume>32</volume>
<issue>2</issue>
<fpage>101</fpage>
<lpage>105</lpage>
<permissions>
<copyright-statement>Copyright 2014, Mary Ann Liebert, Inc.</copyright-statement>
<copyright-year>2014</copyright-year>
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<self-uri content-type="pdf" xlink:type="simple" xlink:href="pho.2013.3646.pdf"></self-uri>
<abstract>
<title>Abstract</title>
<p>
<bold>
<italic>Objective:</italic>
</bold>
The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT).
<bold>
<italic>Background data:</italic>
</bold>
LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results.
<bold>
<italic>Patients and methods:</italic>
</bold>
We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor ≤4 cm, predominant exophytic growth and intraparenchymal depth ≤1.5 cm, with a minimum distance of 5 mm from the urinary collecting system.
<bold>
<italic>Results:</italic>
</bold>
We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma.
<bold>
<italic>Conclusions:</italic>
</bold>
Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found.</p>
</abstract>
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<name sortKey="Grkovic, Marija Topalovic" sort="Grkovic, Marija Topalovic" uniqKey="Grkovic M" first="Marija Topalovic" last="Grkovic">Marija Topalovic Grkovic</name>
<name sortKey="Kastelan, Zeljko" sort="Kastelan, Zeljko" uniqKey="Kastelan Z" first="Zeljko" last="Kastelan">Zeljko Kastelan</name>
<name sortKey="Knezevic, Nikola" sort="Knezevic, Nikola" uniqKey="Knezevic N" first="Nikola" last="Knezevic">Nikola Knezevic</name>
<name sortKey="Krhen, Ivan" sort="Krhen, Ivan" uniqKey="Krhen I" first="Ivan" last="Krhen">Ivan Krhen</name>
<name sortKey="Kulis, Tomislav" sort="Kulis, Tomislav" uniqKey="Kulis T" first="Tomislav" last="Kulis">Tomislav Kulis</name>
<name sortKey="Maric, Marjan" sort="Maric, Marjan" uniqKey="Maric M" first="Marjan" last="Maric">Marjan Maric</name>
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