Introduction of a new laser-scalpel for partial kidney resection based on 1.94 micrometer fiber laser system: initial in vivo-data

摘要

The technique of nephron sparing surgery has matured significantly over the past decade and is emerging as an oncologically sound procedure for the management of renal tumors. Methods of tumor excision as well as parenchymal reconstruction in a hemostaticallly controlled field have evolved to make this procedure safer. In an attempt to find an improoved hemostatic cutting instrument we developed a 1.94 micrometer Laser-Scalpel system in a porcine model.rnWe evaluated data for partial porcine kidney resection performed by a 1.94 micrometer Laser-Scalpel and compared the data to those of a standard HF- (High-Frequency) dissection device. In 12 pigs general anesthesia and a median laparotomy was performed to expose both kidneys. In each pig one kidney was partially resected with the Laser-Scalpel and the other side with the HF-dissection device. The first 6 pigs were euthanized immediately after the procedure. The following 6 pigs were allowed to recover and underwent 2-3 weeks later euthanasia. The final evaluation data included total resection time, blood loss, mass of dissected tissue, total ischemic time and histological examination.rnMean resected kidney tissue mass was 4.75 g with the laser system and 5.57 g for the HF-dissector, respectively. Mean estimated blood loss was 22 ml for the Laser-Scalpel and 78.2 ml for the HF-dissection device. Resection time was 9.45 min for the Laser-scalpel compared to 10.16 min. No complications, specifically no postoperative bleeding, occured in any of the animals. Histological evaluation with H&E staining showed a carbonized zone of about 0.57 mm directly at the dissected edge followed by a thermal damaged zone of about 1.25 mm in width. Thereafter healthy tissue was found in all histological samples.rnPartial kidney resection was easily and fast performed by the use of a 1.94 micrometer Laser-Scalpel system. Hemostasis was highly sufficient, so blood loss was minimal compared to conventional HF-dissection device. Therefore the 1.94 micrometer Laser-Scalpel system is a very promising dissection device for urological surgery.