NEPHRON-SPARING LAPAROSCOPIC SURGERY - TECHNIQUES TO CONTROL THE RENAL PEDICLE AND MANAGE PARENCHYMAL BLEEDING

Laparoscopic nephron-sparing surgery has been limited by several facto rs, including problems in the control of the vascular pedicle and the management of parenchymal bleeding. In an effort to improve the effica cy of laparoscopic nephron-sparing surgery, we developed and tested se veral techniques to control and manage intraoperative renal bleeding w hile performing 30 laparoscopic anatrophic nephrolithotomies using the porcine model. Control of the renal pedicle and management of bleedin g included the use of the following: (1) extracorporeally applied atra umatic vascular pedicle clamp; (2) Argon Beam Coagulator to perform th e capsulotomy; (3) electrocautery scissors to perform the nephrotomy; (4) Gelfoam welded to the cut surface of the parenchyma with the argon beam coagulator; (5) Surgicel welded to the outer surface of the kidn ey with the Coagulator; and (6) laparoscopically applied holster sutur es to further stabilize the renal unit. All animals tolerated the proc edure well and survived to their appointed date of sacrifice. We concl ude that these techniques may improve the efficacy of laparoscopic ren al surgery, including nephron-sparing procedures.