Utility of the harmonic scalpel for laparoscopic partial nephrectomy

Area of Science:

• Urology
• Surgical Technology

Background:

• Laparoscopic partial nephrectomy (LPN) presents challenges in achieving consistent parenchymal hemostasis.
• Effective hemostasis is critical for successful LPN outcomes.

Purpose of the Study:

• To evaluate the harmonic scalpel's efficacy in achieving hemostasis during LPN.
• To determine the influence of resection extent on harmonic scalpel hemostasis.
• To define appropriate applications of the harmonic scalpel in LPN.

Main Methods:

• Thirty LPNs were performed in a domestic pig model.
• The laparoscopic harmonic scalpel (LaparoSonic Coagulating Shears) was used to divide parenchyma at power level 5.
• Three resection types were standardized: peripheral wedge biopsy, pole nephrectomy, and heminephrectomy.
• Bleeding was graded 0-4, with grades ≤2 considered clinically significant.

Main Results:

• Inadequate hemostasis showed a significant trend with increasing resection extent (P < 0.02).
• Mean hemostasis scores decreased from 3.3 (wedge) to 3.0 (pole) to 2.4 (heminephrectomy).
• Clinically significant bleeding (grade ≥2) occurred in 9% (wedge), 25% (pole), and 57% (heminephrectomy) of cases.

Conclusions:

• Harmonic scalpel hemostasis efficacy is inversely related to parenchymal resection extent in LPN.
• The harmonic scalpel is suitable for smaller resections like wedge biopsies.
• Larger resections (heminephrectomy) require supplemental coagulation; their use with the harmonic scalpel alone is not recommended due to high hemorrhage rates.