Comparison between a 1.92-µm fiber laser and a standard HF-dissection device for nephron-sparing kidney resection in a porcine in vivo study.

ABSTRACT

Nephron-sparing surgery was performed in a porcine model with a 1.92-µm fiber laser dissection device in comparison to a standard high-frequency dissection device. In nine pigs, general anesthesia and a median laparotomy were performed to expose both kidneys. On six kidneys (three HF and three laser) a partial renal parenchyma resection of the lower pole without opening of the renal pelvis was performed (group A). On 12 kidneys (four HF and eight laser), a hemi nephrectomy with opening of the renal pelvis was performed (group B). Total resection time including hemostasis of the remaining tissue was 501 ± 394 s in group "A-laser " vs. 176 ± 139 s in group "A-HF". For the group "B", the total resection time was 1174 ± 501 s (B laser) vs. 960 ± 407 s (B-HF). Blood loss was 28 ± 22 ml in group "A laser " vs. 15 ± 15 ml in group "A-HF". In group "B", the blood loss was 98 ± 73 ml (B laser) vs. 137 ± 118 ml (B-HF). No ischemic time for the kidneys was needed in group "A" for both dissection devices. In group "B", ischemia of the kidneys was performed three times during the eight laser procedures (420 ± 60 s) and only once at the four HF procedures (1,260 s). Healing process was observed over 4-6 weeks, survival rate was 100%, and no renal fistulas were found after the survival period. In conclusion, no significant differences were found between the compared dissection devices. However, the laser system with the flexible transmission fiber may have an advantage for a laparoscopic approach by steerable instruments.