[What does Revolix laser contribute to partial nephrectomy?].

OBJECTIVE: Partial nephrectomy is a technique that requires extensive manipulation and control of the renal vessels. In this paper we will evaluate the contribution of Revolix laser to the minimally invasive and nephron sparing renal surgery over the years 2005-2008.
METHODS: We have used the Revolix laser (Thulium), with a wavelength of 2013 nm in the infrared (invisible) spectrum, which can work in a continue or pulsed manner. Its chromophore target is water. Two different techniques may be employed: vaporization (side firing fiber) or vaporresection (frontal fiber). In all cases we used the frontal fiber (rigifib, flexifib and percufib), for vaporresection between 12 and 15 watts. A total of nine patients underwent treatment between 2005 and 2008. We performed one laparoscopic partial nephrectomy and eight open partial nephrectomies through a lumbar incision. In all partial nephrectomies except three (open) the pedicle was clamped.
RESULTS: All patients, seven males and two females, had a favourable outcome, without relevant complications. The cases were six tumors in the left kidney and 3 in the right. Mean tumor size was 3.5 cm, being seven of them localized in the lower pole and two in the upper pole. Mean surgical time was 135 minutes with conventional open surgery and 210 minutes with laparoscopic partial nephrectomy. Estimated blood loss was 156 cc for laparoscopic partial nephrectomy and 260 cc for open surgery. One case was performed under renal hypothermia with 50 minutes ischemia time.
CONCLUSION: Revolix laser offers an excellent haemostasis and precise dissection of the renal cortex. The absence of bubbles and the minimal formation of gases favour its use in laparoscopic surgery. It coagulates vessels of up to 1.6 mm allowing good sealing of the bloody surface. With the use of this type of laser surgical times are shorter, because there is no need to perform sutures of the renal parenchyma.