Focal radiofrequency coagulation-assisted laparoscopic partial nephrectomy: a novel nonischemic technique

HABIB 4X is a laparoscopic focal radiofrequency-coagulation (FRFC) device utilized in liver and kidney resections to facilitate dissection while minimizing blood loss. We evaluated the ergonomics and safety of a laparoscopic FRFC device for a non-ischemic laparoscopic partial nephrectomy (LPN) in a survival porcine model.

Five female pigs (10 renal units) underwent 14 laparoscopic transperitoneal partial nephrectomies using the laparoscopic FRFC device without hilar clamping. In phase 1, either one or multiple segments of the lower, upper, or middle pole were resected following FRFC of the resection plane. Large entries into the collecting system were sutured, while very small rents were left open. Following 2-week survival, a laparoscopic FRFC-assisted heminephrectomy without hilar clamping was performed on the opposite renal unit (phase 2). Both kidneys were then harvested for histologic examination. Retrograde pyelography (RGP) was used to assess the collecting system integrity of the kidneys treated in phase 1.

All 14 LPNs were performed successfully without hilar clamping or open conversion. On average, the resected segments comprised 12.3% of the kidney in phase 1 and 34.8 % in phase 2, with a mean estimated blood loss of 45 mL and 76.5 mL, respectively. At harvest, no hematomas or perinephric collections were observed. RGP revealed urinary extravasation in two renal units that were not repaired. Histologic examination of the resection margin revealed hemorrhage and inflammation with some hyalinization of the proximal and distal tubules, none extending deeper than 3 mm.

The FRFC-assisted non-ischemic porcine LPN is feasible and safe and can be accomplished with minimal bleeding, even with large resections. The laparoscopic FRFC device holds promise in decreasing the inherent difficulty of LPN by obviating the need for laparoscopic suturing to control small parenchymal vessels, as well as in reducing the deleterious effects of warm renal ischemia. Clinical evaluation of this device is warranted.