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Introduction: Developments in laparoscopic partial nephrectomy (LPN) opened a demand for surgical tools compatible
with laparoscopic manipulations to make laser assisted technique safe, feasible and reproducible. Warm ischemia and
bleeding during laparoscopic partial nephrectomy place technical constraints on surgeons. Therefore it was the aim to
develop a safe and effective laser assisted partial nephrectomy technique without need for ischemia.
Patients and methods: A diode laser emitting light at 1318nm in cw mode was coupled into a bare fibre (core diameter
600 μm) thus able to transfer up to 100W to the tissue. After dry lab experience, a total of 10 patients suffering from
kidney malformations underwent laparoscopic/retroperitoneoscopic partial nephrectomy. Clinically, postoperative renal
function and serum c-reactive protein (CRP) were monitored. Laser induced coagulation depth and effects on resection
margins were evaluated. Demographic, clinical and follow-up data are presented. Using a commercial available fibre
guidance instrument for lanringeal intervention, the demands on an innovative laser fibre guidance instrument for the
laser assisted laparoscopic partial nephrectomy (LLPN) are summarized.
Results: Overall, all laparascopic intervention were succesfull and could be performed without conversion to open
surgery. Mean operative time and mean blood loss were comparable to conventional open and laparascopic approaches.
Laser assisted resection of the kidney tissue took max 15min. After extirpation of the tumours all patients showed
clinical favourable outcome during follow up period. Tumour sizes were measured to be up 5cm in diameter. The depth
of the coagulation on the removed tissue ranged between <1 to 2mm without effect on histopathological evaluation of
tumours or resection margin. As the surface of the remaining kidney surface was laser assisted coagulated after removal.
The sealing of the surface was induced by a slightly larger coagulation margin, but could not measured so far. Based on
this experiences a simple and easy to use instrument described serving also for suction and rinsing.
Conclusion: This prospective in-vivo feasibility study shows that laser assisted partial nephrectomy seems to be a safe
and promising medical technique which could be provided either during open surgery as well as laparascopically. This
application showed good haemostasis and minimal parenchymal damage. Further investigations and development are
needed for on-line detection of the remain coagulation margin. An optimised treatment equipment will support the
applicability of laser assisted laparoscopic partial nephrectomy.
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