Published online Jun 16, 2022. doi: 10.12998/wjcc.v10.i17.5646
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
Laparoscopic partial nephrectomy has been widely used in renal cell carcinoma treatment. The efficacy of GreenLight laser on Laparoscopic partial nephrectomy is still unknown. To present the first series of laparoscopic partial nephrectomy (LPN) by GreenLight laser (KTP) 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.
To date, surgical therapy is still the primary treatment, especially in patients with a small renal mass, although surveillance is under study. Recent guidelines indicate that, as far as possible, all patients with tumors < 7 cm should receive nephron-sparing surgery (NSS). The disease-specific prognosis is similar between radical nephrectomy and partial nephrectomy (PN), with the benefit of better protection of kidney function in PN patients. Thus, a critical target of NSS is to preserve the maximum amount of kidney parenchyma, with minimum warm ischemia time (WIT). Hilar clamping has been standard practice in previous decades to achieve the lowest blood loss. However, blockage of the renal blood supply results in WIT, and even renal function damage. Bleeding is still the most frequent complication of NSS, with a risk of transfusion in up to 5% of patients.
To present the first series of LPN by GreenLight laser enucleation without renal artery clamping. Due to the excellent coagulation and hemostatic properties of the laser, LLPN makes it possible to perform a “zero ischemia” resection.
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.
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).
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.
GreenLight laser has extraordinary cutting and sealing advantages when applied to exogenous T1a tumors during LPN; GreenLight reduced the substantial sutures; GreenLight could lead to excessive smoke.