Jorge Subirá Ríos (2010)
The objective of my PhD Thesis was to test the viability of a new device to obtain hemostasis during laparoscopic partial nephrectomy (LPN) without vascular clamping. We performed a comparative experimental study between a new radiofrequency (RF)- assisted device consisting of a handheld instrument that simultaneously conducts coagulation and cutting tasks without hilar clamping vs. a standard technique with hilar clamping. A porcine model was used (10 animals per group) with survival of 17 days.
We obtained the following results: The estimated blood loss with the new device was significantly lower than with the standard technique (15.5 ± 23.7 vs. 79.4 ± 76.3 mL). Although transection time was longer with the new device (10.7 ± 13.7 vs. 2.1 ± 1.2 min), the total operative time was significantly shorter (35.3 ± 13.7 vs. 60.2 ± 10.5 min). Evidence of localized urinary extravasation (urinoma) was identical in both groups (five cases). The group subjected to the new device, however, showed a significantly higher number of cases of leakage after conducting the methylene-blue test: eight (80%) cases vs. only one (11%) with the standard technique. Necrosis depth was significantly greater with the new device (6.6 ± 0.9 vs < 1 mm).
In conclusion, the experimental results suggest that the proposed RF-assisted device provides adequate hemostatic control during transection of the renal parenchyma without additional instruments or surgical maneuvers and could therefore be a valuable adjunct for LPN without vascular clamping. The device was unsuccessful in effectively sealing the collecting system.