Laparoscopic partial nephrectomy of solid renal masses without hilar clamping using a monopolar radiofrequency device (TissueLink).

We reviewed our initial experience with laparoscopic partial nephrectomy for solid renal masses without clamping the renal vasculature using a monopolar device with low-volume saline irrigation for blunt dissection, hemostatic sealing, and coagulation of the renal parenchyma (TissueLink). From September 2002 to January 2004, 16 patients underwent transperitoneal LPNx. In all cases, the renal hilum was dissected without vascular clamping. Either the TissueLink DSTM dissecting sealer or the TissueLink Floating Ball was used to bluntly dissect the tumor free, while simultaneously sealing and coagulating the bleeders. Of the 16 patients, 14 had solid renal masses and 2 had complex cysts. Average: Age, 54.6 years (range: 42-72); ASA score, 2.3 (range: 2-4); tumor size, 3.9 cm (range: 2.1-8); peripheral location in 13 and central in 3; OR time, 232 minutes (range: 144-280); 1 patient had blood transfusion, all tumor margins were negative, and there were 2 open conversions. Two patients had prolonged urine leak from the lower pole calyx managed with ureteral stenting and Foley drainage. Hospital stay was 1.3 days (range: 1-3), and pain medication usage was minimal. Laparoscopic partial nephrectomy can be performed without renal vascular clamping. The TissueLink technology allows complete tumor resection and provides adequate parenchymal hemostasis of the tumor bed. Its scant tissue charring production does not interfere with the pathological assessment of the tumor margins status.

Michael Woods, Freddy Mendez, Raju Thomas, and Rodney Davis. Tulane University School of Medicine, Department of Urology, New Orleans, LA.