Observational Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Jun 16, 2022; 10(17): 5646-5654
Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5646
“Zero ischemia” laparoscopic partial nephrectomy by high-power GreenLight laser enucleation for renal carcinoma: A single-center experience
Xiang-Min Zhang, Ji-Dong Xu, Jian-Min Lv, Xiu-Wu Pan, Jian-Wei Cao, Jian Chu, Xin-Gang Cui
Xiang-Min Zhang, Xiu-Wu Pan, Jian-Wei Cao, Xin-Gang Cui, Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, Shanghai 200092, China
Xiang-Min Zhang, Jian Chu, Department of Urology, Shanghai Baoshan Luodian Hospital, Shanghai 201908, China
Ji-Dong Xu, Department of Urology, Gongli Hospital of The Second Military Medical University, Shanghai 200135, China
Jian-Min Lv, Department of Urology, Shanghai The Seventh People's Hospital, Shanghai 200137, China
Author contributions: Cui XG contributed to conception and design; Zhang XM, Xu JD, Lv JM contributed to acquisition of data; Zhang XM, Xu JD, Lv JM, Pan XW contributed to analysis and interpretation of data; Zhang XM, Lv JM, Cui XG contributed to writing, review, and/or revision of the manuscript; Pan XW, Cao JW, Chu J, Cui XG contributed to administrative, technical, or material support; Cui XG contributed to study supervision; Zhang XM, Xu JD, and Chu J contributed equally to this work and should be considered as co-first authors.
Supported by the Program of Shanghai Academic/Technology Research Leader, No. 19XD1405100; the Clinical Research Plan of SHDC, No. SHDC2020CR4025; Hospital Funded Clinical Research, Xin Hua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, No. 21XHDB06.
Institutional review board statement: Ethical approval for all research procedures was provided by the Scientific Research Review and Investigation Committee of Gong Li Hospital, Second Military Medical University.
Conflict-of-interest statement: The authors state that there is no potential conflict of interest.
Data sharing statement: All data are available on reasonable request via email from the corresponding author.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Xin-Gang Cui, MD, PhD, Chief Doctor, Professor, Research Scientist, Department of Urology, Xinhua Hospital, Shanghai Jiaotong University, School of Medicine, No. 1665 Kongjiang Road, Shanghai 200092, China. cuixingang@xinhuamed.com.cn
Received: November 4, 2021
Peer-review started: November 4, 2021
First decision: March 3, 2022
Revised: March 16, 2022
Accepted: April 9, 2022
Article in press: April 9, 2022
Published online: June 16, 2022
Processing time: 217 Days and 1.7 Hours
Abstract
BACKGROUND

Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment. The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown.

AIM

To present the first series of laparoscopic partial nephrectomy (LPN) by GreenLight laser enucleation without renal artery clamping. Due to the excellent coagulation and hemostatic properties of the laser, laser-assisted LPN (LLPN) makes it possible to perform a “zero ischemia” resection.

METHODS

Fifteen patients with T1a exogenous renal tumors who received high-power GreenLight laser non-ischemic LPN in our hospital were retrospectively analyzed. All clinical information, surgical and post-operative data, complications, pathological and functional outcomes were analyzed.

RESULTS

Surgery was successfully completed in all patients, and no open or radical nephrectomy was performed. The renal artery was not clamped, leading to no ischemic time. No blood transfusions were required, the average hemoglobin level ranged from 96.0 to 132.0 g/L and no postoperative complications occurred. The mean operation time was 104.3 ± 8.2 min. The postoperative removal of negative pressure drainage time ranged from 5.0 to 7.0 d, and the mean postoperative hospital stay was 6.5 ± 0.7 d. No serious complications occurred. Postoperative pathological results showed clear cell carcinoma in 12 patients, papillary renal cell carcinoma in 2 patients, and hamartoma in 1 patient. The mean creatinine level was 75.0 ± 0.8 μmol/L (range 61.0-90.4 μmol/L) at 1 mo after surgery, and there were no statistically significant differences compared with pre-operation (P > 0.05). The glomerular filtration rate ranged from 45.1 to 60.8 mL/min, with an average of 54.0 ± 5.0 mL/min, and these levels were not significantly different from those before surgery (P > 0.05).

CONCLUSION

GreenLight laser has extraordinary cutting and sealing advantages when used for small renal tumors (exogenous tumors of stage T1a) during LPN. However, use of this technique can lead to the generation of excessive smoke.

Keywords: GreenLight laser; Zero ischemia; Partial nephrectomy; Laparoscopy; Renal tumor

Core Tip: GreenLight laser has extraordinary cutting and sealing advantages when applied to exogenous T1a tumors during laparoscopic partial nephrectomy; GreenLight reduced the substantial sutures; GreenLight could lead to excessive smoke.