Use of Concentrated Human Albumin with Argon-Beam Coagulation in Laparoscopic Partial Nephrectomy

Abstract

Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure mainly because of the lack of reliable methods of hemostasis. We evaluated the feasibility of using concentrated human albumin with argon-beam coagulation to control hemorrhaging and urinary leakage during LPN. Six domestic swine underwent heparinization, then lower-pole LPN after renal-hilar vascular control had been obtained. The animals received argon-beam coagulation either alone (control) or with 38% albumin. Three days later, an identical procedure was performed on the contralateral kidney. Retrograde pyelography was employed to assess for urine leakage. The animals were then euthanized, and both kidneys were harvested for histologic examination. The mean operative and warm-ischemia times were similar in the two groups and were 27 and 15 minutes, respectively, using albumin with argon-beam coagulation and 25 and 16 minutes with argon coagulation alone. The albumin group required shorter coagulation times (187 v 312 seconds; P = 0.04), which resulted in less thermal injury. By retrograde pyelography, two kidneys (33%) in the albumin group and all six in the control group had urine leakage. Adding concentrated albumin to argon-beam coagulation substantially increases the reliability and durability of parenchymal repair after LPN. The time needed to achieve stable hemostasis and closure of the collecting system was reduced compared with standard argon-beam coagulation.