Laparoscopic Partial Nephrectomy Using Holmium Laser in a Porcine Model

OBJECTIVE To evaluate the utility of the holmium laser for partial nephrectomy in a porcine model. METHODS Transperitoneal lower pole laparoscopic partial nephrectomy was performed in 5 farm pigs. All animals underwent a left-sided laparoscopic partial nephrectomy and were kept alive for 2 weeks (survival group). Subsequently, a right laparoscopic partial nephrectomy was performed (acute group), and the animals were sacrificed. A 1000-microm (n=6) or 550-microm (n=4) end-fire holmium laser fiber set at 0.2 joules and 60 pulses per second was used to transect the lower pole of the kidney 1 cm below the level of the hilum. The cut parenchymal surface was then sealed with fibrin glue in the survival animals. The operated on kidneys were inspected grossly and evaluated microscopically. RESULTS Laser transection was successfully completed in all cases, and hemostasis proved adequate without any adjunctive measures. No perioperative complications occurred. Estimated blood loss was less than 50 cc for each laparoscopic partial nephrectomy. The acute and survival pigs showed no statistically significant differences in specimen size or weight. Serum creatinine levels were normal in all survival animals. Extravasation was noted on retrograde pyelograms of 2 animals in the survival group. CONCLUSIONS The Holmium:YAG laser provides an efficacious modality for transecting the kidney in a porcine model. Clinical trials are necessary to determine its role in laparoscopic partial nephrectomy in humans.