Purpose: Laparoscopic partial nephrectomy (LPN) with hilar clamping represents the various challenges associated with warm ischemia. We tested the feasibility, and acute and chronic outcomes of LPN using a potassium-titanyl-phosphate (KTP) laser without vascular hilar clamping in the survival calf model.
Materials and methods: Six Jersey calves weighing 76 to 94 kg underwent a total of 12 staged bilateral transperitoneal laser LPNs of the mid/lower pole using an 80 W KTP laser, including left kidney chronic LPN with 1-month followup in 6 and right kidney acute LPN with immediate sacrifice in 6. Two techniques (ablative vaporization in 5 subjects and wedge resection in 7) were evaluated. Renal parenchymal resection and hemostasis were achieved only with the laser without any adjunctive hemostatic sutures or bioadhesives. Retrograde pyelography, renal arteriography and histological analyses were performed.
Results: All 12 procedures were successful performed laparoscopically without open conversion and 11 (92%) were done without hilar clamping. Mean total operative time was 2.9 hours (range 1.5 to 5) and mean blood loss was 119 cc (range 25 to 300). Mean lasing time was 56 minutes (range 20 to 100) with an average energy use of 54 kJ. Mean preoperative and postoperative hemoglobin (10.38 and 10.52 gm/dl) and serum creatinine (0.46 and 0.4 gm/dl, respectively) were similar. At 1-month followup there was no evidence of urinary leakage or arteriovenous fistula.
Conclusions: This initial study of laparoscopic KTP laser partial nephrectomy without hilar clamping confirms its technical feasibility in most cases and good short-term outcomes. This success of laser LPN in the robust survival calf model with its human-sized kidney holds promise for future clinical application.