V5-08: ZERO—ISCHEMIA LAPAROSCOPIC PARTIAL NEPHRECTOMY FOR T2 KIDNEY CANCER USING A SALINE-JET DISSECTOR
VideoIntroductions and Objectives
Current paradigms in nephron sparing surgery for localised kidney cancer support a minimally-invasive approach with zero-ischaemia preferable where possible. However, there is as yet no standardised technique to achieve this._x000D_ Since September 2013, we have performed laparoscopic partial nephrectomy without hilar clamping, using an ERBEJET® dissector for parenchymal dissection. This device delivers a variable-pressure jet of saline for parenchymal dissection, via a disposable rigid laparoscopic handpiece with integrated suction. Haemostasis is achieved with advanced bipolar diathermy._x000D_ The objective of this video is to illustrate the surgical technique.
The video presents this surgery in a 62 year old patient with a 75mm right lower pole tumour, using a transperitoneal approach._x000D_ As the renal parenchyma is progressively dissected using the saline-jet, the intrarenal vessels and collecting system are clearly visualised and left in-tact by the water-jet. Minor vessels are specifically controlled using bipolar vessel sealing; major vessels and collecting system are controlled using either locking polymer clips or bipolar diathermy.
In our current series of 30 patients with this technique, that includes our learning curve, surgical times are shorter than for on-clamp laparoscopic partial nephrectomies at our centre. There have been no instances of delayed secondary haemorrhage from AVM. Urine leak has occurred in 13% of patients and has prompted consideration of elective stent placement in selected patients.
This technique allows minimally invasive nephron sparing surgery for localised kidney cancer, with zero ischemia and without hilar vessel dissection. The saline-jet dissection allows direct visualisation of vessels and collecting system enabling specific control. Renorrhaphy is usually omitted, reducing risk of associated ischemia and of secondary arteriovenous malformation from suture cut-through._x000D_ _x000D_ The simplicity of this innovative technique, and its relatively short learning curve, may facilitate dissemination of zero-ischemia laparoscopic partial nephrectomy surgery.