Laparoscopic thulium fiber laser partial nephrectomy without thermal ischemia

Abstract

Background. Laparoscopic partial nephrectomy (LPN) in the treatment of small kidney tumors is widespread, but the operation is associated with warm ischemia, which adversely affects the functional state of the kidney. Research is underway on methods of partial nephrectomy with a reduction of thermal ischemia or zero ischemia. The laser energy is one of the directions in the search for options for LPN. The aim of our work is to improve the LPN using a thulium laser. Materials and methods. From 2017 to 2019 a LPN was performed for 16 patients with small tumors, using the thulium laser with a wavelength of 1.94 ^m. There were men 7 (43.8 %), women — 9 (56.2 %), average age was 51 (39—68) years, average kidney tumor size was 24.9 (15—40) mm. The evaluation of laser resectability on the RENAL scale was carried out using 3D modeling. We used the laparoscopic laser aspirator-irrigator to reduce smoke generation during the procedures. Results. The average time of LPN using a fiber thulium laser was 97.5 (70—131) min. The time for kidney resection was 25.6 (10—40) min. 14 (87.5 %) procedures performed completely without warm ischemia. The average blood loss during surgery was 111.3 (50—250) ml. The duration of postoperative treatment was 7.1 (5—9) days. A positive surgical margin was not observed. Histological examination revealed renal cell carcinoma in 14 (87.5 %) patients, G2 — 10 (71.4 %), G2 — 4 (28.6 %). When examining glomerular filtratoin rare in the operated patients after procedures, no changes were observed. Conclusion. The use of the thulium laser for LPN allows perform the procedure without warm ischemia in selected patients with a predominantly extrarenal tumor location. The use of a laparoscopic instrument the laser aspirator-irrigator with a drip water supply and simultaneous aspiration reduced smoke generation during laser thulium resection, the operation performed under conditions of improved visualization, which prevents the danger of a positive surgical edge. Further monitoring of the results of applying the method of thulium laser LPN is required.