Efficacy of the argon beam coagulator alone in obtaining hemostasis after laparoscopic porcine heminephrectomy: a pilot study.

INTRODUCTION

The argon beam coagulator (ABC) is used in combination with other hemostatic agents and suture renorrhaphy to obtain hemostasis after laparoscopic partial nephrectomy. We performed a pilot study evaluating the efficacy of the ABC-alone in obtaining hemostasis during laparoscopic heminephrectomy (LHN) in a porcine model.

METHODS

Eight pigs (4 small (30 kg-40 kg) and 4 large (70 kg-80 kg)), underwent bilateral LHN. Hemostasis then was obtained by using the ABC at 120W as a single modality. The collecting system was not repaired. The hilum was unclamped and the renal defect observed for 20 minutes with pneumoperitoneum pressure of 4 mmHg. The animals were survived for 24 hours at which time they were sacrificed and necropsy performed.

RESULTS

All small pigs underwent LHN successfully. Mean pre- and post-op Hgb were 11.2 g/dl and 9.8 g/dl, respectively (p=0.12). In one of the animals, ABC at 150W was required to obtain hemostasis. All but one of the large pigs underwent LHN successfully. One of the animals had continuous bleeding despite ABC after right LHN and a completion nephrectomy was performed. Pre and postoperative Hgb for the large pigs were 9.9 g/dl and 9.3 g/dl, respectively (p=0.24).

CONCLUSIONS

The ABC-alone was successful in obtaining hemostasis in all but two of the renal units in both small and large pigs. The two hemostatic failures were noticeable immediately after hilar unclamping. Our data suggest that ABC-alone provides adequate hemostasis when applied to small-caliber vessels. Further long term studies are needed to fully evaluate the efficacy of the ABC.