Nephron-sparing laparoscopic surgery: techniques to control the renal pedicle and manage parenchymal bleeding.

Laparoscopic nephron-sparing surgery has been limited by several factors, including problems in the control of the vascular pedicle and the management of parenchymal bleeding. In an effort to improve the efficacy of laparoscopic nephron-sparing surgery, we developed and tested several techniques to control and manage intraoperative renal bleeding while performing 30 laparoscopic anatrophic nephrolithotomies using the porcine model. Control of the renal pedicle and management of bleeding included the use of the following: (1) extracorporeally applied atraumatic vascular pedicle clamp; (2) Argon Beam Coagulator to perform the capsulotomy; (3) electrocautery scissors to perform the nephrotomy; (4) Gelfoam welded to the cut surface of the parenchyma with the argon beam coagulator; (5) Surgicel welded to the outer surface of the kidney with the Coagulator; and (6) laparoscopically applied bolster sutures to further stabilize the renal unit. All animals tolerated the procedure well and survived to their appointed date of sacrifice. We conclude that these techniques may improve the efficacy of laparoscopic renal surgery, including nephron-sparing procedures.