Hand-Assisted Laparoscopic Partial Nephrectomy: A Controlled Study of Bipolar Inline Radiofrequency Ablation Device in Swine

Abstract

Background: Bipolar inline radiofrequency ablation (ILRFA) is an effective way to control bleeding during parenchymal organ transection. This was investigated in a study of laparoscopic hand-assisted partial nephrectomy in swine. Methods: Nine Landrace pigs were divided between 2 groups; diathermy was employed in the control group for parenchymal transaction and ILRFA was applied in the experimental group through a hand-port and deployed into the resection plane. After complete coagulation, resection was performed using scissors. Results: The mean intraoperative blood loss was 32 ± 15 mL in the ILRFA group and 187 ± 69 mL in the control group: a 82.9% reduction ( P = .015). The mean blood loss per resection area was 2.53 ± 0.92 mL/cm² in the ILRFA group compared with 17.31 ± 9.05 mL/cm² in controls; the reduction was 85.4% (P = .005). Conclusions: ILRFA is effective in achieving reducing blood loss and provides a drier operative field for precise dissection.

Keywords

nephron-sparing surgery laparoscopic partial nephrectomy inline radiofrequency ablation device blood loss

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References

Fergany AF , Hafez KS , Novick AC Long-term results of nephron sparing surgery for localized renal cell carcinoma: 10-year follow up. J Urol. 2000;163:442-445.

Lee CT , Katz J. , Shi W. , Thaler HT , Reuter VE , Russo P. Surgical management of renal tumours 4 cm or less in a contemporary cohort . J Urol. 2000;163:730-736.

Patard JJ , Shvarts O. , Lam JS , et al. Safety and efficacy of partial nephrectomy for all T1 tumors based on an international multicenter experience. J Urol. 2004;171:2181-2185.

Leibovich BC , Blute ML , Cheville JC , Lohse CM , Weaver AL , Zincke H. Nephron sparing surgery for appropriately selected renal cell carcinoma between 4 and 7 cm results in outcome similar to radical nephrectomy. J Urol. 2004;171:1066-1070.

Lesage K. , Joniau S. , Fransis K. , Van Poppel H. Comparison between open partial and radical nephrectomy for renal tumours: perioperative outcome and health-related quality of life. Eur Urol. 2007;51:614-620.

Winfield HN , Donovan JF , Godet AS , Clayman RV Laparoscopic partial nephrectomy: initial case report for benign disease. J Endourol. 1993;7:521-526.

Moinzadeh A. , Gill IS , Finelli A. , Kaouk J. , Desai M. Laparoscopic partial nephrectomy: 3-year follow up. J Urol. 2006; 175:459-462.

Thompson T. , Ng CF , Tolley D. Renal parenchymal hemostatic aids: glues and things. Curr Opin Urol. 2003;13:209-214.

Yao P. , Morris DL Radiofrequency ablation-assisted liver resection: review of the literature and our experience. HPB (Oxford). 2006;8:248-254.

10.

Yao P. , Gunasegaram A. , Ladd LA , Morris DL InLine bipolar radiofrequency ablation device assisted partial nephrectomy in a porcine model. ANZ J Surg. 2008;78:564-567.

11.

Yao P. , Gunasegaram A. , Ladd LA , Morris DL A novel surgical management of renal trauma: InLine radiofrequency ablation coagulation. ANZ J Surg. 2008;78:601-604.

12.

Yao P. , Gunasegaram A. , Ladd LA , Chu F. , Morris DL InLine RFA assisted laparoscopic resection: first experiment with stapling device. ANZ J Surg. 2007;77:480-484.

13.

Herr HW A history of partial nephrectomy for renal tumors. J Urol . 2005;173:705-708.

14.

Ficarra V. Open radical nephrectomy versus open partial nephrectomy: is it still an issue ? Eur Urol. 2007;51:593-595.

15.

Tan YH , Young MD , L’Esperance JO , Preminger GM , Albala DM Hand-assisted laparoscopic partial nephrectomy without hilar vascular clamping using a saline-cooled, high-density monopolar radiofrequency device. J Endourol. 2004;18:883-887.

16.

Collyer WC , Landman J. , Olweny EO , et al. Comparison of renal ablation with cryotherapy, dry radiofrequency, and saline augmented radiofrequency in a porcine model. J Am Coll Surg. 2001;193:505-513.

17.

Miao Y. , Ni Y. , Bosmans H. , et al. Radiofrequency ablation for eradication of renal tumor in a rabbit model by using a cooled-tip electrode technique. Ann Surg Oncol. 2001;8:651-657.

18.

Herrell SD , Levin BM Laparoscopic partial nephrectomy: use of the TissueLink hemostatic dissection device. J Endourol. 2005;19:446-449.

19.

Oefelein MG Delayed presentation of urinoma after radiofrequency ablation-assisted laparoscopic partial nephrectomy. J Endourol . 2006;20:27-30.

20.

Cherif M. , Rouache L. , Tapon E. , et al. Usefulness of an inline radiofrequency device in renal allograft preserving surgery. Transplantation. 2007;83:522-523.