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KMID : 1001020200180020155
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Journal of Urologic Oncology
2020 Volume.18 No. 2 p.155 ~ p.160
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Open Partial Nephrectomy With Zero Ischemia Technique Using Thulium Laser: Our Experience of 4 Cases
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Prem Kumar
Kumar Pankaj
Rehman Zia Ur
Janoria Somesh
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Abstract
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With the advent of newer technologies, the management of small renal masses has shown a paradigm shift. This has resulted in preferring partial nephrectomy over radical nephrectomy, emphasizing the concept of nephron sparing surgery. Various lasers have been used in few cases. We prospectively evaluated the use of thulium laser in open partial nephrectomy over last 1 year. The aim is to study thulium laser as an energy source for partial nephrectomy for peripheral tumor. The role of partial nephrectomy and zero ischemia time in renal preservation is already proven. Outcomes of total of 4 patients who underwent open partial nephrectomy were analyzed prospectively. We used Quanta Cyber TM laser at setting of 30 W both for cutting and coagulation. Preoperative characteristics and outcomes were analyzed. Four patients underwent open partial nephrectomy with zero ischemia. The mean tumor size was 5.26 cm, mean RENAL nephrometry score was 4.5, mean operative time was 67.5 minutes, active laser time was 2 minutes, mean blood loss related to partial nephrectomy per se was 65 mL. Mean preoperative hemoglobin was 11.12 g% and mean postoperative hemoglobin was 10.05 g%. Mean duration of stay was 6 days. Histologically all lesions were renal cell carcinoma pT1/T2, with margins negative for tumor and no deterioration in renal function during follow-up. The thulium laser at 2013 nm wavelength demonstrates excellent hemostasis and precise cutting capabilities of the renal cortex during open partial nephrectomy for peripheral tumors without requiring renal artery clamping.
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KEYWORD
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Open partial nephrectomy, Zero ischemia, Nephron sparing surgery, Thulium laser
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