Mr A R Rao, Mr G Lee, Mr 0 M A Karim Department of Urology, Wexham Park Hospital, Slough, Introduction: Wells performed the first partial nephrectomy in 1884 for removal of a perirenal fibrolipoma and in 1890, Czerny was the first to perform a partial nephrectomy for a renal neoplasm. Since then, Urologists have always turned towards technological advances to find ways to minimise blood loss occurring at the time of surgery. In industry, waterjet technology has been used for many years in applications ranging from precision cutting of diamonds to slicing of pre-packed sandwiches. The hydro-jet dissector has been used extensively to dissect with high tissue selectivity in gall bladder surgery, liver and splenic resection. The technology relies on the action of an extremely thin laminar liquid jet, rotating like a drill on the surface of the tissue. With its precision method of operation and action it ensures a particularly sensitive, precise and safe dissection with shorter procedure times. It has also the advantage of tissue preservation in the surgical margin, which has a prognostic implication in partial nephrectomy for malignant tumours. We present two cases of partial nephrectomy, which, utilised the hydro-jet dissector and the argon beam coagulator from incision to closure These devices minimised blood loss and demonstrated the potential use of these innovative technologies in urology. We believe it is the first time this combination of technology has been used for a no-scalpel partial nephrectomy in the world.
Two patients presented to us with recurrent pyelonephritis. On both the patients investigations revealed a poorly functioning upper pole moiety of a duplex collecting system. Both patients underwent upper pole partial nephrectomy using the Helix Hydro-jet [email protected]
and Argon Beam Coagulator. The kidney was approached through the flank in both the cases. The operating time, blood loss, post-operative period and recovery were analysed. No scalpel was used for any part of the operation. The salient features of the operation are demonstrated in the video presentation.
Results: Both the patients underwent successful operations. The operative times were 115 minutes and 135 minutes from skin to skin. The renal resection time was 20 minutes and 24 minutes respectively. The amount of saline used for partial resection of the kidneys was 240ml and 290 ml whereas blood loss was 25 ml and 45 ml respectively. No intra-operative or post-operative complications were encountered. Post-operative drain collection was 60 ml and 100 ml over 2 days respectively.
Conclusion: These two cases were the first in the UK to use the hydrojet dissector in partial nephrectomy. Utilising the two technologies, we believe these cases represent the first report in the world of noscalpel partial nephrectomy. The safety of these technologies has prompted us to consider a randomised control trial to compare this new technique with standard partial nephrectomy.