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Ex vivo and animal study of the blue diode laser, Tm fiber laser, and their combination for laparoscopic partial nephrectomy
摘要： Background and Objectives: To evaluate the feasibility of using a novel blue diode laser (blue laser), a thulium fiber laser (Tm laser), and their combination as a directed‐energy surgical tool in laparoscopic partial nephrectomy (LPN). Study Design/Materials and Methods: The blue laser emitting at 442 nm, the Tm laser emitting at 1,940 nm wavelengths, and the combination of them were tested. First, cutting and coagulative abilities of the lasers were characterized ex vivo on porcine kidney in air and CO2. Histological staining was performed to assess the efficiency of ablation and coagulation. Next, experimental LPN was performed on a porcine model at zero ischemia. Upper and lower segments of both kidneys were resected. Total operation time and resection time were measured; bleeding and carbonization were evaluated. Results: Ex vivo data show that laser‐induced ablation and coagulation processes do not differ substantially between CO2 and air environments. Histological analysis of ex vivo incisions demonstrates that the blue laser produced deep ablation with relatively narrow coagulation zone, whereas Tm laser was less efficient in terms of ablation but possessed excellent coagulative properties. Experimental LPN revealed that the blue laser provided fast cutting with minimal carbonization, whereas Tm laser induced slow cutting with strong carbonization. The combination of the blue and Tm lasers provided the most promising results demonstrating the highest resection rate, almost carbonization free resection surface and clinically acceptable hemostasis enabling LPN without the need for vessel clamping. Conclusions: The blue laser can be efficiently utilized in LPN. Furthermore, the combination of the blue and Tm lasers into a single modality may be beneficial for further development of successful laser‐assisted LPN.
关键词： Tm fiber laser,laparoscopic partial nephrectomy,porcine model,blue diode laser
更新于2025-09-19 17:13:59
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Laparoscopic Partial Nephrectomy by Diode Laser with Highly Selective Clamping of Segmental Renal Arterial
摘要： The treatment of small renal masses has shifted from radical nephrectomy to partial nephrectomy, in particular, laparoscopic partial nephrectomy. Renal artery clamping is often necessary to minimize hemorrhage during resection in cases of partial nephrectomy. However, renal artery clamping may lead to greater incidence of renal malfunction after partial nephrectomy. Therefore, novel techniques which could both avoid renal artery occlusion and achieve adequate hemostasis are urgently required. Selective renal segmental artery clamping was one of several common methods that could achieve “zero ischemia.” At the same time, a number of reports about laser?assisted partial nephrectomy on humans using multiple kinds of outstanding coagulative specialties of lasers were published. Among facilities with clinical use of lasers, diode laser emitting a wavelength of 980 nm has been recently utilized in the human body operations. The purpose of our clinical research was to evaluate the effectiveness and safety of application of diode laser (980 nm wavelength) in laparoscopic partial nephrectomy with highly selective clamping of the segmental renal arterial.
关键词： Highly Selective Clamping,Partial Nephrectomy,Diode Laser
更新于2025-09-16 10:30:52
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Near-infrared Fluorescence Imaging with Indocyanine Green in Robot-assisted Partial Nephrectomy: Pooled Analysis of Comparative Studies
摘要： Context: The use of near-infrared fluorescence (NIRF) imaging was described to facilitate selective clamping during robot-assisted partial nephrectomy (RAPN). Objective: To perform a systematic review and cumulative analysis of available studies comparing the outcomes of RAPN with or without use of this technology (NIRF). Evidence acquisition: A systematic review of the literature was performed to identify relevant studies up to December 2018 through PubMed and EMBASE databases. A meta-analysis was conducted with the RevMan 5.3 software. Evidence synthesis: Six comparative studies were identi?ed. Overall, 369 cases were included for the analysis (171 NIRF-RAPN and 198 standard RAPN). No signi?cant difference was identi?ed between groups in baseline characteristics, operating time, and estimated blood loss; however, a shorter clamping time was recorded for the NIRF-RAPN group. Functional outcomes revealed higher overall estimated glomerular ?ltration rate (eGFR) values in the NIRF-RAPN group at short-term (1–3 mo) postoperative follow-up (weighted mean difference [WMD]: 9.26 ml/min; 95% con?dence interval [CI]: 6.46, 12.06; p < 0.001). In two studies, a renal scan-based assessment of split eGFR was available, and pooled analysis revealed higher split eGFR for NIRF-RAPN (WMD: 7.91 ml/min; 95% CI: 4.26, 11.56; p < 0.001), and lower % between preoperative and 1-mo eGFR (WMD: ?7.84%; 95% CI: ?8.85, ?6.83; p < 0.00001). Conclusions: Current evidence regarding the use of NIRF-guided selective clamping during RAPN is based on a limited number of studies from high-volume institutions. Notwithstanding these limitations, NIRF-RAPN can be safely performed, and it might offer better short-term renal functional outcomes. It remains to be determined whether this can ultimately translate into a clinical bene?t for patients undergoing RAPN, especially in the long term.
关键词： Robotic surgery,Indocyanine green,Near-infrared fluorescence,Partial nephrectomy
更新于2025-09-12 10:27:22