725 NOVEL HIGH-INTENSITY FOCUSED ULTRASOUND CLAMP – POTENTIAL ADJUNCT FOR LAPAROSCOPIC PARTIAL NEPHRECTOMY

Abstract

You have accessJournal of UrologyTechnology & Instruments: Robotics/Laparoscopy/Ureteroscopy I1 Apr 2010725 NOVEL HIGH-INTENSITY FOCUSED ULTRASOUND CLAMP – POTENTIAL ADJUNCT FOR LAPAROSCOPIC PARTIAL NEPHRECTOMY Jonathan D. Harper, Stuart B. Mitchell, Yak-Nam Wang, Anup R. Shah, Michael R. Bailey, and Lawrence A. Crum Jonathan D. HarperJonathan D. Harper More articles by this author , Stuart B. MitchellStuart B. Mitchell More articles by this author , Yak-Nam WangYak-Nam Wang More articles by this author , Anup R. ShahAnup R. Shah More articles by this author , Michael R. BaileyMichael R. Bailey More articles by this author , and Lawrence A. CrumLawrence A. Crum More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2010.02.1213AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Coinciding with the increase in detection of small renal masses, there is evidence that nephron-sparing surgery may result in improved long-term renal outcomes. Partial nephrectomy can be technically challenging, especially if performed in a minimally invasive manner. New ultrasound technology has therapeutic capabilities and has been used for tissue ablation and hemostasis. The purpose of this paper is to introduce a high-intensity ultrasound clamp that could potentially aid in laparoscopic partial nephrectomy. METHODS A new instrument was created using a laparoscopic PEER retractor. Ultrasound elements were engineered on both sides of the retractor in order to administer high-intensity ultrasound energy between the two sides of the clamp. This device was tested on the upper and lower poles of porcine kidneys to evaluate its effectiveness at different levels and duration of energy delivery. Histology was performed with H & E and NADH staining to evaluate for tissue viability and thermal spread. RESULTS Gross parenchymal changes were seen with obvious demarcation between treated and untreated tissue. There was no evidence of thermal spread outside the clamped margin. Increased ultrasound exposure time (10 vs 5 and 2 minutes), even at lower power settings seemed to be more beneficial in causing destruction and necrosis of tissue. CONCLUSIONS This novel “HIFU” clamp could serve as a useful adjunct to laparoscopic partial nephrectomy in the future by developing a plane of cauterization surrounding the mass, decreasing blood loss during excision and potentially obviate the need for renal hilar clamping. Seattle, WA© 2010 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 183Issue 4SApril 2010Page: e283 Advertisement Copyright & Permissions© 2010 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jonathan D. Harper More articles by this author Stuart B. Mitchell More articles by this author Yak-Nam Wang More articles by this author Anup R. Shah More articles by this author Michael R. Bailey More articles by this author Lawrence A. Crum More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...