The Harmonic Scalpel in the Infant Upper Pole Heminephrectomy

Abstract

PURPOSE Upper-pole heminephrectomy is commonly performed in pediatric urology for non-functioning moieties often associeated with ureteroceles. We have modified our open approach to incorporate the Harmonic Scalpel (Johnson and Johnson) and have found that this facilitates and simplifies the procedure. MATERIAL AND METHODS Three patients ranging in age from 3-6 months underwnt a modified flank heminephrectomy for non-functioning duplicated upper pole segment. Pre-operative evaluation included renal bladder ultrasound, voiding cystourethrogram, and nuclear renal scan. The upper-pole moiety was exposed in conjunction with its ureter. Its blood supply was defined using demarcation after applying a bulldog clamp to the small sub-tending vessels. The Harmonic Scalpel (Johnson and Johnson) was then used to separate the upper pole as demonstrated in the video. Following this the ureter was divided near the bladder. RESULTS Operative time was less than 90 minutes in all three procedures. Blood loss was negligable (< 10 cc). All patients were discharged by post-operative day 2. A followup renal ultrasound at three months demonstrated a normal appearing lower pole moiety in all patients. CONCLUSIONS The harmonic scalpel simplifies the open upper pole heminephrectomy. It is a compact precision tool which simultaneously cuts and coagulates. Because it limits lateral thermal damage, it decrease the possibility of injury to the lower pole vascular pedicle. We found it simple to use and recommend its use for these procedures.