Abstract
Objectives
Evaluation of clamp-off laser-assisted laparoscopic partial nephrectomy technique (LLPN) compared to the clamp-off laparoscopic (LPN) and open (OPN) techniques.
Patients and methods
Between September 2008 and July 2011, 36 patients suffering from small peripheral renal tumours (RT) underwent LLPN (n = 12), LPN (n = 12) and OPN (n = 12) in a prospective single-centre study. RT were excised with laser, Sonosurg or monopolar scissors during LLPN, LPN and OPN, respectively. Blood vessels are identified and sutured before opening them; alternatively, laser energy was used to coagulate them (LLPN). Early and late postoperative complications were assessed. Follow-up was done according to EAU-guidelines.
Results
Mean age was 64.9 years. Mean operative time was 135.8 min (100–180) versus 144.2 (85–255) versus 113.6 (50–170) for LLPN versus LPN versus OPN, respectively. Median estimated blood loss (EBL) was 170.8 ml (50–600) versus 245.2 (50–700) versus 425.8 (100–900) for LLPN versus LPN versus OPN, respectively. Tumours (19 right and 17 left) were located in upper (11), midparenchyma (13) and lower pole (12). Mean tumour size was 2.7 cm (1.2–5.5). There were no reported perioperative complications/conversions. There were no positive margins. Histological evaluations were not compromised in any LLPN-case. Compared to LPN, LLPN offered significant lower EBL, shorter operative time, otherwise, comparable results. Follow-up was uneventful without tumour recurrences.
Conclusion
Current prospective comparative study shows that LLPN is a reproducible efficient alternative to LPN/OPN. Besides the absence of renal ischaemia, LLPN offered lower EBL, good haemostasis and minimal parenchyma damage. Surgical and oncological outcomes are comparable to LPN and OPN.
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References
Pierre S, Preminger GM (2007) Holmium laser for stone management. World J Urol 25:235–239
Descazeaud A, Robert G, Azzousi AR, Ballereau C, Lukacs B, Haillot O, Dumonceau O, Devonec M, Fourmarier M, Saussine C, de la Taille A (2009) Committee for lower urinary tract symptoms of the French Association of Urology. Laser treatment of benign prostatic hyperplasia in patients on oral anticoagulant therapy: a review. BJU Int 103:1162–1165
Campbell SC, Novick AC, Belldegrun A et al (2009) Guideline for management of the clinical T1 renal mass. J Urol 182:1271–1279
Lane BR, Gill IS (2007) 5-Year outcomes of laparoscopic partial nephrectomy. J Urol 177:70
Allaf ME, Bhayani SB, Rogers C et al (2004) Laparoscopic partial nephrectomy: evaluation of long-term oncological outcome. J Urol 172:871
Jeong W, Park SY, Lorenzo EI, Oh CK, Han WK, Rha KH (2009) Laparoscopic partial nephrectomy versus robot-assisted laparoscopic partial nephrectomy. J Endourol 23:1457–1460
Williams SB, Kacker R, Alemozaffar M, Francisco IS, Mechaber J, Wagner AA (2011) Robotic partial nephrectomy versus laparoscopic partial nephrectomy: a single laparoscopic trained surgeon’s experience in the development of a robotic partial nephrectomy program. World J Urol [Epub ahead of print]
Lane BR, Gill IS (2010) 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol 183:473–479
Porpiglia F, Volpe A, Billia M, Scarpa RM (2008) Laparoscopic versus open partial nephrectomy: analysis of current literature. Eur Urol 53:732–743
Wheat JC, Roberts WW, Hollenbeck BK, Wolf JS Jr, Weizer AZ (2011) Complications of laparoscopic partial nephrectomy. Urol Oncol 28 [Epub ahead of print]
Louie MK, Deane LA, Kaplan AG, Lee HJ, Box GN, Abraham JB, Borin JF, Khan F, McDougall EM, Clayman RV (2011) Laparoscopic partial nephrectomy: six degrees of haemostasis. BJU Int 107:1454–1459
Khoder WY, Sroka R, Hennig G, Seitz M, Siegert S, Zillinberg K, Gratzke C, Stief CG, Becker AJ (2011) The 1,318-nm diode laser supported partial nephrectomy in laparoscopic and open surgery: preliminary results of a prospective feasibility study. Lasers Med Sci 26:689–697
Weizer AZ, Gilbert SM, Roberts WW et al (2008) Tailoring technique of laparoscopic partial nephrectomy to tumor characteristics. J Urol 180:1273–1278
Khoder WY, Sroka R, Kellhammer N, Haseke N, Stief CG, Becker AJ (2011) Laser-assisted laparoscopic partial nephrectomy without ischemia: procedure and challenges. J Endourol Part B Videourol. doi:10.1089/vid.2010.0155
Ramani AP, Desai MM, Steinberg AP, Ng CS, Abreu SC, Kaouk JH, Finelli A, Novick AC, Gill IS (2005) Complications of laparoscopic partial nephrectomy in 200 cases. J Urol 173:43–47
Turna B, Frota R, Kamoi K et al (2008) Risk factor analysis of postoperative complications in laparoscopic partial nephrectomy. J Urol 179:1289–1295
Eret V, Hora M, Sykora R, Hes O, Urge T, Klecka J, Matejovic M (2009) GreenLight (532 nm) laser partial nephrectomy followed by suturing of collecting system without renal hilar clamping in porcine model. Urology 73:1115–1118
Bui MH, Breda A, Gui D, Said J, Schulam P (2007) Less and minimal tissue carbonization using a thulium laser for laparoscopic partial nephrectomy without hilar clamping in a porcine model. J Endourol 21:1107–1111
Anderson JK, Baker MR, Lindberg G, Cadeddu JA (2007) Large-volume laparoscopic partial nephrectomy using the potassium-titanyl-phosphate (KTP) laser in a survival porcine model. Eur Urol 51:749–754
Gruschwitz T, Stein R, Schubert J, Wunderlich H (2008) Laser-supported partial nephrectomy for renal cell carcinoma. Urology 71:334–336
Mattioli S, Muñoz R, Recasens R, Berbegal C, Teichmann H (2008) What does Revolix laser contribute to partial nephrectomy. Arch Esp Urol 61:1126–1129
Seitz M, Sroka R, Gratzke C, Schlenker B, Steinbrecher V, Khoder W, Tilki D, Bachmann A, Stief C, Reich O (2007) The diode laser: a novel side-firing approach for laser vaporisation of the human prostate—immediate efficacy and 1-year follow-up. Eur Urol 52:1717–1722
Khoder WY, Seroka R (2011) Concept of a fiber guidance instrument for laser-assisted laparascopic partial nephrectomy. Med Laser Appl 26:176–182
Acknowledgments
The authors would like to thank the Rolle&Rolle Company, Austria for their support during this study.
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I disclose any commercial association that might pose a conflict in connection with my submitted article.
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Khoder, W.Y., Sroka, R., Siegert, S. et al. Outcome of laser-assisted laparoscopic partial nephrectomy without ischaemia for peripheral renal tumours. World J Urol 30, 633–638 (2012). https://doi.org/10.1007/s00345-011-0807-8
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DOI: https://doi.org/10.1007/s00345-011-0807-8