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Laparoscopic Partial Nephrectomy With Potassium-titanyl-phosphate Laser Versus Conventional Laparoscopic Partial Nephrectomy: An Animal Randomized Controlled Trial. | LitMetric

AI Article Synopsis

  • - The study aimed to compare the safety and effectiveness of potassium-titanyl-phosphate laser laparoscopic partial nephrectomy (KTP-LPN) against conventional laparoscopic partial nephrectomy (C-LPN) using 30 pigs as subjects.
  • - All procedures were successfully performed, but the KTP-LPN group experienced higher immediate complications, including two deaths from urinary fistulas, whereas the C-LPN group saw one death from heart issues and another from hyperthermia.
  • - Although KTP-LPN showed potential for safety and feasibility, it resulted in worse short-term renal function compared to C-LPN, suggesting the need for more research before it can be widely adopted in clinical settings.

Article Abstract

Objective: To explore the feasibility, safety, and short-term results of potassium-titanyl-phosphate (KTP) laser laparoscopic partial nephrectomy (KTP-LPN) vs conventional laparoscopic partial nephrectomy (C-LPN).

Materials And Methods: Thirty large white female pigs were randomized to KTP-LPN or C-LPN. Laparoscopic radical right nephrectomy was performed, and an artificial renal tumor was placed in the left kidney in 3 locations. A week later, 15 pigs underwent C-LPN and 15 underwent KTP-LPN. All C-LPNs were performed with renal ischemia. A 120-W setting was used, without arterial clamping in the KTP-LPN group. Follow-up was done at day 1, week 3, and week 6. Retrograde pyelography was performed at 6 weeks, followed by animal sacrifice and necropsy.

Results: All KTP-LPNs were performed without hilar clamping. C-LPNs were performed with hilar clamping, closing of the collecting system, and renorraphy. In the KTP laser group, 2 pigs died due to urinary fistula in the first week after surgery. In the C-LPN group, 1 pig died due to myocardial infarction and another due to malignant hyperthermia. Hemoglobin and hematocrit recovery were lower at 6 weeks in the KTP-LPN group. Renal function 24 hours after surgery was worse in the KTP-LPN group but recovered at 3 weeks and 6 weeks. No differences were observed in surgical margins. The necropsy showed no differences. Limitations of the study are the impossibility to analyze the collecting tissue sealing by the KTP, and the potential renal toxicity of the KTP laser.

Conclusion: Although KTP-LPN is feasible and safe in the animal model, further studies are needed.

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Source
http://dx.doi.org/10.1016/j.urology.2016.03.043DOI Listing

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