Non-ischemic laparoscopic partial nephrectomy using 1318-nm diode laser for small exophytic renal tumors

Area of Science:

• Urology
• Minimally Invasive Surgery
• Oncology

Background:

• Laparoscopic partial nephrectomy (LPN) faces challenges with warm ischemia and bleeding.
• Current research on laser use in LPN is limited by small patient cohorts.

Purpose of the Study:

• To present the largest case series on non-ischemic LPN using a diode laser for small renal tumors.
• To evaluate the efficacy and safety of a 1318-nm diode laser in LPN.

Main Methods:

• Retrospective analysis of 29 patients undergoing non-ischemic laser-assisted LPN for exophytic renal tumors.
• Utilized a 1318-nm diode laser for cutting and coagulation, with non-contact coagulation and contact cutting techniques.
• Renal vessels were not clamped, aiming for zero warm ischemia time (WIT).

Main Results:

• Achieved zero WIT in most cases; one required 12 minutes of warm ischemia and sutures.
• No transfusions were needed, with minimal hemoglobin drop and no postoperative complications.
• Histologically confirmed renal cell carcinoma (pT1a) in most cases, with negative margins in the majority, though charring affected interpretation in some.
• Mean follow-up of 1.8 years showed no tumor recurrence; mean tumor diameter was 19.4 mm.

Conclusions:

• The 1318-nm diode laser effectively cuts and seals small vessels in renal parenchyma during LPN, reducing suture necessity.
• Potential drawbacks include excessive smoke, surgical margin charring, and limitations in sealing larger blood vessels.
• This technique shows promise for non-ischemic LPN in select cases.