Hemostatic laparoscopic partial nephrectomy: Initial experience with the radiofrequency coagulation-assisted technique

Objectives. The techniques for hemostasis after renal tumor excision have l imited the widespread application of laparoscopic partial nephrectomy (LPN) . To improve hemostasis and aid visualization, we report our experience wit h a novel radiofrequency coagulation (RFC) technique for LPN. Methods. Ten patients underwent RFC-assisted LPN. The demographic and perio perative data were tabulated. Patients were positioned as for laparoscopic nephrectomy, and laparoscopic ports were placed. The kidney within Gerota's fascia was mobilized, and the fat overlying the tumor was carefully remove d for pathologic evaluation. Under laparoscopic guidance, a radiofrequency probe was percutaneously inserted into the lesion and deployed to coagulate the lesion and a margin of normal parenchyma. Laparoscopic scissors were u sed to excise the lesion; additional hemostatic maneuvers were used selecti vely. Results. The mean renal tumor size was 2.1 cm (range 1.0 to 3.2). The media n operative time was 170 minutes and the median blood loss was 125 mL. The RFC technique resulted in complete tissue coagulation within the treated vo lume, thereby facilitating intraoperative visualization, minimizing blood l oss, and permitting rapid and controlled tumor resection. The renal archite cture was preserved, allowing accurate diagnosis of renal cell carcinoma an d angiomyolipoma in 9 and 1 cases, respectively. No perioperative complicat ions occurred. Conclusions. The use of RFC is an effective method to facilitate LPN of bot h exophytic and endophytic masses. By coagulating a margin of normal parenc hyma, the technique minimizes blood loss and improves visualization during LPN. We anticipate this technique will broaden the clinical application for LPN. UROLOGY 58: 8-11, 2001. (C) 2001, Elsevier Science Inc.