Abstract
Background
We assessed the extent of apoptotic damage induced by the microwave tissue coagulator (MTC) in the preserved normal renal tissue following partial nephrectomy.
Methods
Eleven patients who underwent nonischemic partial nephrectomy with MTC (group M) were enrolled in this study. The other 11 patients who underwent cold-ischemic partial nephrectomy without the use of MTC were enrolled as controls (group C). There were no significant differences in tumor size or age between the two groups. Renal damage was evaluated by counting apoptotic cells in the normal renal tissue surrounding the tumor tissue. Immunohistochemical staining with single-stranded DNA was carried out to investigate the apoptotic cells.
Results
The number of apoptotic cells in group M ranged from 275 to 508 per 1,000 cells, with a median value of 421. The number in group C ranged from 122 to 466 per 1,000 cells with a median value of 286. The number of apoptotic cells in group M was significantly greater than that in group C (p = 0.006). Blood loss in group C was significantly greater than that in group M (p < 0.0001).
Conclusions
This study points out that renal damage induced by the use of MTC comprises not only necrosis but also apoptotic change. Although MTC is useful for controlling renal parenchymal bleeding during partial nephrectomy, we must consider that renal apoptotic damage caused by the MTC may spread beyond the coagulated necrosis area.
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References
Novick AC. Nephron-sparing surgery for renal cell carcinoma. Annu Rev Med. 2002;53:393–407.
Tabuse K. A new operative procedure of hepatic surgery using a microwave tissue coagulator. Nippon Geka Hokan. 1979;48:160–72.
Hirao Y, Fujimoto K, Yoshii M, Tanaka N, Hayashi Y, Momose H, et al. Non-ischemic nephron-sparing surgery for renal cell carcinoma: complete tumor enucleation using a microwave tissue coagulator. Jpn J Clin Oncol. 2002;32:95–102.
Yoshimura K, Okubo K, Ichioka K, Terada N, Matusta Y, Arai Y. Laparoscopic partial nephrectomy with a microwave tissue coagulator for small renal tumor. J Urol. 2001;165:1893–6.
Muraki J, Schwalb DM, Cord J, Armenakas N, Addonizio JC, Nagamatus GR, et al. Application of microwave tissue coagulation in partial nephrectomy. Urology. 1991;37:282–7.
Kageyama Y, Kihara K, Yokoyama M, Sakai Y, Koga F, Saito K, et al. Endoscopic minilaparotomy partial nephrectomy for solitary renal cell carcinoma smaller than 4 cm. Jpn J Clin Oncol. 2002;32:417–21.
Murota T, Kawakita M, Oguchi N, Shimada O, Danno S, Fujita I, et al. Retroperitoneoscopic partial nephrectomy using microwave coagulation for small renal tumors. Eur Urol. 2002;41:540–5.
Furuya Y, Tsuchida T, Takihana Y, Araki I, Tanabe N, Takeda M. Retroperitoneoscopic nephron-sparing surgery of renal tumor using a microwave tissue coagulator without renal ischemia: comparison with open procedure. J Endourol. 2003;17:53–8.
Terai A, Ito N, Yoshimura K, Ichioka K, Kamoto T, Arai Y, et al. Laparoscopic partial nephrectomy using microwave tissue coagulator for small renal tumors: usefulness and complications. Eur Urol. 2004;45:744–8.
Tanaka N, Fujimoto K, Tani M, Yoshii M, Yoshida K, Hirao Y, et al. Prediction of postoperative renal function by preoperative serum creatinine level and three-dimensional diagnostic image reconstruction in patients with renal cell carcinoma. Urology. 2004;64:904–8.
Kondo T, Nakazawa H, Ito F, Onitsuka O, Ryoji O, Yago R, et al. Impact of arterial occlusion during partial nephrectomy on residual renal function: an evaluation with 99m technetium-dimercatosuccinic acid scintigraphy. Int J Urol. 2002;9:435–40.
Login GR, Dvorak AM. Microwave energy fixation for electron microscopy. Am J Pathol. 1985;120:230–43.
Wolfs T, Vries B, Walter S, Peutz-Kootstra C, Heurn L, Oosterhol G, et al. Apoptotic cell death is initiated during normothermic ischemia in human kidneys. Am J Transplant. 2005;5:68–75.
Satoh Y, Uozumi J, Nanri M, Nakajima K, Kanou T, Tokuda Y, et al. Renal-tissue damage induced by laparoscopic partial nephrectomy using microwave tissue coagulator. J Endourol. 2005;19:818–22.
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Nanri, M., Udo, K., Kawasaki, M. et al. Microwave tissue coagulator induces renal apoptotic damage to preserved normal renal tissue following partial nephrectomy. Clin Exp Nephrol 13, 424–429 (2009). https://doi.org/10.1007/s10157-009-0180-8
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DOI: https://doi.org/10.1007/s10157-009-0180-8