Assessment of Hydrodissection, Holmium:YAG Laser Vaporization of Renal Tissue, and Both Combined To Facilitate Laparoscopic Partial Nephrectomy in Porcine Model

Abstract

To evaluate the modalities of electrocautery, holmium:yttrium-aluminum-garnet (YAG) laser, hydrodissection, and combined holmium:YAG laser with hydrodissection applied to laparoscopic partial nephrectomy (LPN) in a porcine model. A total of 16 Yorkshire pigs were divided into 4 equal groups (electrocautery, hydrodissection, holmium:YAG laser, and combined hydrodissection/holmium:YAG laser) and underwent unilateral LPN. The total operative time, partial nephrectomy time, hemostasis modality, and intraoperative complications were recorded. The pre- and postoperative hemoglobin was measured. Abdominal computed tomography was performed 2 weeks postoperatively. Representative specimens from each arm were examined for histologic findings. The mean total operative time and the time to perform partial nephrectomy was lower for the combined hydrodissection/holmium:YAG laser arm (66 minutes and 13 minutes, respectively) compared with the electrocautery arm (93 and 30 minutes, respectively), holmium:YAG laser-only arm (77 and 19 minutes, respectively), and hydrodissection-only arm (129 and 35 minutes, respectively). The mean decrease in hemoglobin was the least for the combined hydrodissection/holmium:YAG laser arm (5.3 g/L) followed by the holmium:YAG-only (15.3 g/L), hydrodissection-only (16.8 g/L), and electrocautery (35.5 g/L) arms, respectively. The histologic examination demonstrated an increased depth of tissue injury in the electrocautery arm. In a porcine model, the combined use of the hydrodissection/holmium:YAG laser to perform LPN had the shortest operative time and the lowest decrease in hemoglobin and appears to warrant additional clinical evaluation in human trials for LPN.