Laparoscopic partial nephrectomy using the potassium titnyl phosphate laser in a porcine model

Working with an 80 watt KTP laser delivered in a noncontact mode via a 600 micron fiber, these authors successfully completed 15 laparoscopic partial nephrectomies in pigs. This was done without clamping any renal vessels.

In only one case additional hemostatic maneuvers were needed. The zone of necrotic tissue on the renal remnant was only 1 mm. The procedure consumed only 4-17 minutes of lasing time; however the overall time to accomplish the nephrectomies averaged 42 minutes due to production of field obscuring smoke by the laser.

While this report is very encouraging, the reader is cautioned that porcine data DO NOT readily transfer to human experience. Indeed, as Cadeddu and colleagues have shown, the holmium laser was found to be successful for partial nephrectomy in pigs; however, it did not work sufficiently well in the clinical arena to warrant its adaptation. The search for the "bloodless" knife continues*. Certainly in this day and age, one would think that we should have the technology capable of placing in the surgeon's hands, an instrument that would take any vascular organ and allow the surgeon to sculpt it as though it were a block of granite; sealing vessels well in advance of their being severed! Every time we proceed with a standard laparoscopic partial nephrectomy, I still feel like I am being sent out into the woods with a bow and a single arrow in search of a bear. I have only one question: "Where is my bazooka"?

*Lotan, Y., Gettman, M. T., Lindberg, G., et al.: Laparoscopic partial nephrectomy using holmium laser in a porcine model. J. Laparoendosc. Surg. 8:51, 2004.

Written by Ralph V. Clayman, MD - UroToday

Urology 67: 079-1083, May 200