MP04-15 LAPOROSCOPIC PARTIAL NEPHRECTOMY WITH BLUE DIODE, THULIUM FIBER AND HYBRID LASERS. IN VIVO TRIAL ON PORCINE KIDNEY

Abstract

You have accessJournal of UrologySurgical Technology & Simulation: Instrumentation & Technology I (MP04)1 Apr 2020MP04-15 LAPOROSCOPIC PARTIAL NEPHRECTOMY WITH BLUE DIODE, THULIUM FIBER AND HYBRID LASERS. IN VIVO TRIAL ON PORCINE KIDNEY Dmitry Enikeev*, Ekaterina Laukhtina, Mikhail Enikeev, Valeria Arkhipova, Mark Taratkin, Leonid Rapoport, and Petr Glybochko Dmitry Enikeev*Dmitry Enikeev* More articles by this author , Ekaterina LaukhtinaEkaterina Laukhtina More articles by this author , Mikhail EnikeevMikhail Enikeev More articles by this author , Valeria ArkhipovaValeria Arkhipova More articles by this author , Mark TaratkinMark Taratkin More articles by this author , Leonid RapoportLeonid Rapoport More articles by this author , and Petr GlybochkoPetr Glybochko More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000818.015AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Laparoscopic partial nephrectomy (LPN) is beneficial for patients with renal cell carcinoma of clinical stage T1 and T3. The main challenge of this approach is achieving of adequate hemostasis. Dissection of renal parenchyma at Z-ischemia is usually accompanied by severe blood loss, whereas vessels clamping, which is used to prevent bleeding, may result in impairment of renal function as warm ischemia time often exceeds 25-30 minutes. Therefore, a lot of effort has been made towards the development of tools, which allow resection without hilar clamping and maintaining "clean" surgical field at minimum blood loss. In this regard, laser technologies are of particular interest, because they possess optimal cutting and coagulation properties, which can be utilized simultaneously. The aim of this study was the evaluation of the efficacy and safety of a novel blue diode laser (BDL) and thulium fiber (Tm-Fiber) laser, as well as hybrid (BDL + Tm-Fiber) laser for LPN. METHODS: BDL emitting at a wavelength of 442 nm and Tm-Fiber laser emitting at the wavelength of 1942 nm (NTO IRE-Polus, Russia) were used. Both lasers were operated at continuous mode with the following settings: average power Pav = 20 W, pulse energy E = 0.7 J and Pav = 20-40 W, E = 1 - 1.5 J for BDL and Tm-Fiber lasers, respectively. In hybrid laser, the same laser parameters were used. Implementation of BDL in continuous mode should provide resection without carbonization. LPN was performed on a porcine model under Z-ischemia conditions. Laparoscopic lateral transperitoneal approach with 3 working and one optical ports was used. RESULTS: 1. Application of BDL resulted in resection without carbonization. Skin to skin operation time and the laser application time were 37 and 10 minutes, respectively. The area of the resection surface was 5 cm2. Despite the intense smoke production, resection was feasible. 2. Tm-Fiber laser induced strong smoke formation, pronounced carbonization, and slow cutting. Increasing laser power did not improve surgical outcome. The total operation time was 10 minutes, the time of laser implementation was 3 minutes then the operation was stopped. 3. Hybrid laser resulted in the successful resection. Skin to skin operation time and the laser activation time were 11 and 4 minutes, respectively. The resected area was 10 cm2. Resection surface was free of carbonization. Hemostasis was clinically acceptable. However, we were not able to prevent bleeding completely at the final stage of the operation, when the large artery (>2 mm of diameter) was affected. CONCLUSIONS: Hybrid (BDL + Tm-Fiber) laser into a single device may be advantageous for effective and safe LPN. The combination of both lasers allows fast carbonization-free cutting, whereas the coagulative properties of the Tm-Fiber laser enable adequate hemostasis. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e37-e38 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Dmitry Enikeev* More articles by this author Ekaterina Laukhtina More articles by this author Mikhail Enikeev More articles by this author Valeria Arkhipova More articles by this author Mark Taratkin More articles by this author Leonid Rapoport More articles by this author Petr Glybochko More articles by this author Expand All Advertisement PDF downloadLoading ...