Laparoscopic Doppler technology: applications in laparoscopic pyeloplasty and radical and partial nephrectomy.

Introduction: The identification and isolation of vascular structures are crucial and technically demanding aspects of laparoscopic renal surgery. Doppler technology has been used for this purpose in laparoscopic varicocele repair, renal cryoablation, and adrenalectomy. However, it has not been formally described for use in laparoscopic radical nephrectomy, partial nephrectomy, or pyeloplasty. We report our initial experience with Doppler technology in 20 patients undergoing these procedures.

Technical Considerations: A laparoscopic Doppler probe was used in laparoscopic radical nephrectomy (n = 6), partial nephrectomy (n = 8), nephroureterectomy (n = 3), and robotic-assisted pyeloplasty (n = 3). The Doppler system consisted of a disposable 8-MHz probe passed through a 5-mm port and a battery-powered transceiver. The probe was used to guide dissection/isolation of the renal hilum and aberrant vasculature in radical and partial nephrectomy, confirm parenchymal ischemia before resection in partial nephrectomy, and identify crossing vessels during pyeloplasty. Nine accessory vessels were detected in 6 (35%) of 17 patients undergoing radical/partial nephrectomy or nephroureterectomy. In 1 case of partial nephrectomy, persistent parenchymal flow despite renal artery clamping required clamp repositioning. In 1 case of pyeloplasty, the Doppler probe detected a crossing vessel despite negative preoperative imaging findings. Use of the probe altered management in 7 (35%) and saved time in 15 (75%) of 20 cases. No complications were associated with the use of the probe.

Conclusions: Doppler ultrasound technology might have extended applications in laparoscopic renal surgery by facilitating the dissection and evaluation of vasculature. A prospective study with objective endpoints would be helpful in confirming the utility of this technology in these settings.