Thulium laser laparoscopic partial nephrectomy without renal hilar control in a porcine model

Objective: Laparoscopic partial nephrectomy is a technically challenging procedure. The most important step is to achieve hemostasis during parenchymal resection. We evaluated the feasibility of thulium:yttrium-aluminum-garnet (Th:YAG) laser partial nephrectomy in a porcine model. Materials and Methods: We performed bilateral transperitoneal laparoscopic partial nephrectomies with a 600 μm end-firing laser fiber and a 70 W Th:YAG laser setting in five pigs. Perioperative data including operative time, laser time, estimated blood loss and serum creatinine before and after surgery were collected. Ex vivo retrograde pyelography was performed to detect collecting system leakage after specimen removal. Results: Laser resection and hemostasis were successfully accomplished in all cases, and no perioperative complications occurred. Mean estimated blood loss was 50 mL. Mean laser time was 20 minutes. Mean resected renal mass was 25% of total kidney mass. After 14 and 28 days, exploratory laparotomy found no urinoma formation. Conclusion: Laparoscopic partial nephrectomy using Th:YAG laser is a feasible surgical method in the porcine model. Future clinical application is warranted.