Clinical experience with carbon dioxide laser in renal surgery

Rosemberg, Samuel K.

doi:10.1016/0090-4295(85)90524-2

Cited by 26 publications

(2 citation statements)

References 8 publications

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“…7 LPN is a technically challenging procedure, mainly because of the lack of reliable methods of hemostasis and requiring prolonged WIT 14 To date, 12 research groups have published small series concerning clinically tested laser-assisted open or laparoscopic partial nephrectomies. 11,[15][16][17][18][19][20][21][22][23][24][25] To our knowledge, this is largest published series of laser-assisted laparoscopic partial nephrectomy.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Knezevic

Kuliš

Maric

et al. 2014

Photomedicine and Laser Surgery

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Objective: The aim of this study was to evaluate application of diode laser in laparoscopic partial nephrectomy (LPN), and to question this technique in terms of ease of tumor excision and reduction of warm ischemia time (WIT). Background data: LPN is the standard operative method for small renal masses. The benefits of LPN are numerous, including preserving renal function and prolonging overall survival. However, reduction of WIT remains main challenge in this operation. In order to shorten WIT, many techniques have been developed, with variable results. Patients and methods: We performed a prospective collection and analysis of health records for patients who were operated on between March 2011 and August 2012. Inclusion criteria were single tumor £ 4 cm, predominant exophytic growth and intraparenchymal depth £ 1.5 cm, with a minimum distance of 5 mm from the urinary collecting system. Results: We operated on 17 patients. Median operative time was 170 min. In all but two patients, we had to perform hilar clamping. Median duration of WIT was 16 min. Pathohistological evaluation revealed clear cell renal cancer and confirmed margins negative for tumor in all cases. Median size of the tumor was 3 cm. Median postoperative hospitalization was 5 days. Average follow up was 11.5 months. There were no intraoperative complications. One postoperative complication was noted: perirenal hematoma. Conclusions: Laser LPN is feasible, and offers the benefit of shorter WIT, with effective tissue coagulation and hemostasis. With operative experience and technical advances, WIT will be reduced or even eliminated, and a solution to some technical difficulties, such as significant smoke production, will be found.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Knezevic

Kuliš

Maric

et al. 2014

Photomedicine and Laser Surgery

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“…However, it is now not only used for such mandatory cases but also electively in patients with relatively small tumors or lesions that are suspected to be benign since the introduction of new techniques for preventing excessive blood loss and avoiding deterioration of the renal function by clamping the renal pedicle [1][2][3][4].…”

Section: Introductionmentioning

confidence: 99%

Application of the Microwave Tissue Coagulator: Is It Beneficial to Partial Nephrectomy?

et al. 2002

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Background/Aim: The indications of partial nephrectomy have expanded after the introduction of new techniques for preventing excessive blood loss and avoiding deterioration of the renal function after clamping the renal pedicle. We present our clinical experience of partial nephrectomy for renal tumors using a microwave tissue coagulator. Patients and Methods: Between April 1996 and January 2000, 34 patients underwent open partial nephrectomies in the Kobe City General Hospital. The microwave tissue coagulator was used for resection of the renal parenchyma, but in deeper lesions a sharp dissection was performed. Twenty-two patients (groups 1 and 2) underwent partial nephrectomy without vascular control (14 renal pedicles were not disturbed in group 1 patients, and 8 renal pedicles were dissected but not clamped in group 2 patients). Another 12 patients (group 3) underwent vascular control with ligation of the tumor-feeding segmental arteries before parenchymal resection. The patients of group 1 underwent wedge resections, while those of groups 2 and 3 underwent segmental or transverse partial nephrectomies. Results: Complete tumor resection was done in all 34 patients. In group 1, the microwave tissue coagulator was very effective to control the blood loss (mean 330 ml). In larger resections, this method only was inadequate to control the blood loss (mean 489 ml in group 2), so that we needed vascular control. However, despite vascular control, mean blood losses of about 943 ml because of deeper venous bleeding occurred in group 3, and, moreover, postoperative renal infarctions occurred in 2 patients. Other complications were urinary fistula formation in 16 patients (47%) and renal pelvic stenoses in 2 patients (5.8%). All of the urinary fistulas were easily repaired by simple suturing intraoperatively. Conclusions: Especially in wedge resection, the microwave tissue coagulator achieved safe resection without vascular control which differs from other new techniques. However, in larger resections, a combination with other techniques may be necessary to decrease blood loss and the rate of complications.

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Partial nephrectomy using the Nd:YAG Laser: A comparison of the 1.06 μ and 1.32 μ lasers employing different delivery systems

et al. 1988

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A comparative study of the 1.06 mu and the 1.32 mu Nd:YAG laser using a variety of delivery systems (focusing handpiece, freehand GI quartz fiber, or frosted laser scalpel) was undertaken to determine the usefulness of these modalities in performing partial nephrectomies in dogs. Variables evaluated included total operative time, total joules expended, estimated amount of blood loss, and extent of renal tissue damage. The contact laser scalpel provided the greatest precision and speed, but no hemostasis, and is therefore inappropriate for parenchymal renal surgery. Evaluation of the other delivery systems showed no discernible differences in the extent of renal damage that could be attributed to either wavelength or wattage used. The usual depth of acute renal damage ranged from 1.0 mm to 1.8 mm when the tissue was fixed immediately after completing the polar nephrectomy, but the damage had extended to 3.0 mm when tissue was examined after 6 weeks. No consistent differences in extent of cellular damage could be demonstrated between the renal cortex and medulla. The lens system inherent in the focusing handpiece limited the total power (60 watts) that could be employed and surgery proceeded at a slower pace and required a greater expenditure of energy. Likewise, the maximal power that could be applied using the 1.32 mu laser was 25 watts and surgery also proceeded at a slower pace.(ABSTRACT TRUNCATED AT 250 WORDS)

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Clinical experience with carbon dioxide laser in renal surgery

Cited by 26 publications

References 8 publications

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Laparoscopic Partial Nephrectomy with Diode Laser: A Promising Technique

Application of the Microwave Tissue Coagulator: Is It Beneficial to Partial Nephrectomy?

Partial nephrectomy using the Nd:YAG Laser: A comparison of the 1.06 μ and 1.32 μ lasers employing different delivery systems

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