Large-Volume Laparoscopic Partial Nephrectomy Using the Potassium-Titanyl-Phosphate (KTP) Laser in a Survival Porcine Model

Objectives: Laparoscopic partial nephrectomy (LPN) remains a technically challenging procedure primarily because of difficulties with hemostasis. In an attempt to develop a hemostatic cutting instrument for laparoscopic partial nephrectomy, we evaluated the potassium-titanyl-phosphate (KTP) laser for use during large-volume laparoscopic partial nephrectomy in a porcine model. Methods: Transperitoneal lower pole laparoscopic partial nephrectomy was performed in six pigs. Two nonsurvival animals were used initially to develop the laser technique. Four animals underwent a right-sided laparoscopic laser partial nephrectomy followed by an identical left-sided procedure 2 weeks later. Renal hilar occlusion was used in all cases. A novel 365-μm end-firing laser fibre and 80-W KTP laser were used for resection and hemostasis. All renal remnants underwent retrograde pyelography and histologic examination. Results: Laser resection and hemostasis was successfully completed in all cases, and no perioperative complications occurred. Mean estimated blood loss was 80 ml (25-250 ml). Mean laser and warm ischemia times were 35 and 34 minutes, respectively. Resection speed was limited by smoke formation but not by cutting or hemostatic efficiency of the laser. Mean resected kidney mass was 30 g or 25% of total kidney mass. There were no urinomas, but, on retrograde pyelogram, extravasation was noted in seven of eight kidneys (87.5%). Conclusions: The KTP laser provides hemostasis during large-volume resection in the porcine kidney. This technique appears promising for laparoscopic partial nephrectomy in humans.