Hemostatic properties of four devices for partial nephrectomy: a comparative ex vivo study

Laparoscopic partial nephrectomy (LPN) is a common minimally-invasive treatment modality for renal tumors, and achieving hemostasis during excision is a major challenge. The aim of our study was to investigate the hemostatic potential of four different devices for realizing this under standardized conditions.

LPN was performed on a standardized model of blood-perfused ex-vivo porcine kidneys. Each of the four devices (Greenlight KTP laser, Habib Sealer, LigaSure, and SonoSurg) as well as a scalpel (for comparison) were used to perform 10 excisions with the renal artery and vein clamped, and another 10 were performed with no clamping. Treatment time (TT), blood loss (BL), and the ease of handling of the device were measured and histologic examination of the margins was carried out.

In general, TT was faster and there was less BL with clamping than without in all cases. TT was shortest for the KTP laser (6.07+/-1.2 minutes; P<0.0001), followed by the LigaSure (8.78+/-0.42 minutes), the SonoSurg (15.9+/-1.28 minutes), and the Habib (21.7+/-3.4 min). The SonoSurg showed a significantly higher BL without clamping (66+/-6 ml, p<0.0001) but there were no significant differences between the other devices. With clamping, BL four all four devices was comparable (13+/-2 ml) and without statistical significance (p=0.5). TT was shortest for the KTP laser (3.27+/-0.55 min, p<0.0001) followed by the LigaSure (6.47+/-0.38 s), the SonoSurg (8.35+/-3 min) and the Habib (9.71+/-1.18 minutes). The excised surface was completely coagulated for all of the devices except for the SonoSurg.

Our ex-vivo study suggests that hemostatic potential and the coagulative effect of all four devices is inadequate. Furthermore, none of the devices produced clean and sharp resection margins, which is a prerequisite for negative surgical margins.