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Radiofrequency coagulation-assisted laparoscopic partial nephrectomy without hilar clamping: a feasible technique
Hiten D Patel1, Phillip M Pierorazio, Jeffrey K Mullins
1Brady Urological Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Background And Purpose:
The Habib radiofrequency coagulation (RFC) device coagulates bleeding surfaces and may eliminate the need for hilar clamping, thus eliminating warm ischemia time and decreasing the technical complexity of laparoscopic partial nephrectomy (LPN). We retrospectively review a series of patients who underwent clampless LPN with RFC to study the safety and feasibility of this approach.
Patients And Methods:
The Institutional Review Board-approved, Johns Hopkins Minimally Invasive Urologic Surgery Database (1994-2011) was queried for patients undergoing clampless LPN with RFC between September 2008 and January 2010 by a single surgeon (MEA). Respecting a 0.5-cm surgical margin, the lesion was circumscribed with the RFC device to create an avascular plane, and standard laparoscopic shears were used to excise the tumor in a bloodless field without hilar clamping. Patient outcomes were analyzed for safety and feasibility of this approach.
Results:
Fifteen patients underwent RFC LPN. Median tumor diameter in our patients was 1.6 cm (range 1-7.3 cm). Seven (46.7%) tumors were exophytic in nature, and the remainder were mesophytic. Median nephrometry score was 5 (range 4 to 7). Median operative time was 155 minutes (range 100-210 min), and median estimated blood loss was 100 mL (50-500 mL). There were no positive margins, and two postoperative complications (urine leak and clot retention) were encountered. No recurrences were noted with short-term follow-up.
Conclusion:
Clampless RFC LPN can be performed safely in carefully selected patients with favorably positioned tumors. In this initial experience, we observed excellent perioperative and short-term oncologic outcomes. Future comparative studies will dictate the role of RFC-assisted LPN in the armamentarium of kidney surgeons.
