Laparoscopic simple enucleation and coagulation on tumor bed using argon beam coagulator for treating small renal cell carcinomas: an animal study followed by clinical application

Abstract

Material/methods: The animal experiments of coagulation therapy on the wound tissue bed during partial nephrectomy with an argon beam coagulator were performed on 16 rabbits, which were randomly divided into 4 groups. Groups A and B had renal artery occlusion; the treatment time of coagulation was 4 seconds and 6 seconds, respectively. Groups C and D did not have renal artery occlusion; the treatment time of coagulation was 2 seconds and 4 seconds, respectively. Then 30 clinical operations of laparoscopic simple enucleation and coagulation on tumor bed using an argon beam coagulator were performed.

Results: All 16 rabbits successfully underwent the operation. By the histological examination, the scab depth of the wound tissue bed in groups A, B, C, and D were 2.76 ± 0.17 mm, 3.15 ± 0.15 mm, 2.28 ± 0.16 mm and 2.75 ± 0.06 mm, respectively. Group A differed significantly from groups B and C (P=0.012, 0.007), and group D differed significantly from groups B and C (P=0.002, 0.002). In the clinical study, all 30 patients successfully underwent the operation. The mean operative time was 182 minutes, and the mean blood loss was 280 ml. With a median follow-up time of 37 months, neither local recurrence nor distant metastasis was found by computerized tomography scan.

Conclusions: Laparoscopic simple enucleation and coagulation on tumor bed using an argon beam coagulator can be considered for treating small renal cell carcinomas. However, the indication of this procedure should be highly selected.

Figures

Figure 1

(A) The demonstration of coagulation therapy on the wound tissue bed using an argon beam. (B) CT scan demonstrated a renal cell carcinoma, which was in the lateral portion of the kidney (arrow). (C) Compact structure in the area of scab, and the granulation tissue was found between renal tissue and scab (HE ×40). (D) Calcification was found in the area of necrosis (HE ×40).

Figure 2

The scab depth of the 4 group rabbits’ kidneys. Group A differed significantly from group B & C (P=0.012, 0.007), as well as group D from group B & C (P=0.002, 0.002), but no significant difference between group A and group D (P=0.915).