JOURNAL OF ENDOUROLOGY Volume 22, Number 6, June 2008 © Mary Ann Liebert, Inc. Pp. 1269–1273 DOI: 10.1089/end.2008.0022 Focal Radiofrequency Coagulation–Assisted Laparoscopic Partial Nephrectomy: A Novel Nonischemic Technique Ilia S. Zeltser, M.D., 1 Amit Gupta, M.D., M.P.H., 2 Karim Bensalah, M.D., 2 Wareef Kabbani, M.D., 2 Adam Jenkins, B.A., 2 Sangtae Park, M.D., M.P.H., 2 Margaret S. Pearle, M.D., Ph.D., 2 and Jeffrey Cadeddu, M.D. 2 Abstract Objective: HABIB 4X™ is a laparoscopic focal radiofrequency-coagulation (FRFC) device utilized in liver and kidney resections to facilitate dissection while minimizing blood loss. We evaluated the ergonomics and safety of a laparoscopic FRFC device for a non-ischemic laparoscopic partial nephrectomy (LPN) in a survival porcine model. Methods: Five female pigs (10 renal units) underwent 14 laparoscopic transperitoneal partial nephrectomies us- ing the laparoscopic FRFC device without hilar clamping. In phase 1, either one or multiple segments of the lower, upper, or middle pole were resected following FRFC of the resection plane. Large entries into the col- lecting system were sutured, while very small rents were left open. Following 2-week survival, a laparoscopic FRFC-assisted heminephrectomy without hilar clamping was performed on the opposite renal unit (phase 2). Both kidneys were then harvested for histologic examination. Retrograde pyelography (RGP) was used to as- sess the collecting system integrity of the kidneys treated in phase 1. Results: All 14 LPNs were performed successfully without hilar clamping or open conversion. On average, the resected segments comprised 12.3% of the kidney in phase 1 and 34.8% in phase 2, with a mean estimated blood loss of 45 mL and 76.5 mL, respectively. At harvest, no hematomas or perinephric collections were observed. RGP revealed urinary extravasation in two renal units that were not repaired. Histologic examination of the resection margin revealed hemorrhage and inflammation with some hyalinization of the proximal and distal tubules, none extending deeper than 3 mm. Conclusion: The FRFC-assisted non-ischemic porcine LPN is feasible and safe and can be accomplished with minimal bleeding, even with large resections. The laparoscopic FRFC device holds promise in decreasing the inherent difficulty of LPN by obviating the need for laparoscopic suturing to control small parenchymal ves- sels, as well as in reducing the deleterious effects of warm renal ischemia. Clinical evaluation of this device is warranted. 1269 Introduction T HE ROUTINE USE of ultrasound and computed tomogra- phy for the evaluation of abdominal symptoms has led to a 60% increase in the rate of incidental detection of small (4 cm) renal tumors. 1 Most of these tumors are of low stage and therefore may be managed by nephron-sparing surgery (NSS), even in the presence of a normal contralateral kidney. NSS has been proven to offer long-term preservation of re- nal function with recurrence-free survival equivalent to that of radical nephrectomy in selected patients. 2 LPN is now performed in many centers of excellence; however, widespread implementation of this technique has been limited. 3 Slow adoption of this technique is partly due to several drawbacks that have yet to be overcome. LPN is a technically challenging procedure and requires complete proficiency with intracorporeal suturing. Even for the most experienced laparoscopic surgeons, ischemia time is 50% longer than that of open surgery and hypothermia is rarely performed. 4 New data indicate that even a short interval of warm ischemia can significantly increase the risk of acute re- nal failure and chronic renal insufficiency. 5 Thus, there is a 1 Bryn Mawr Urology Group, Bryn Mawr, Pennsylvania, and 2 University of Texas Southwestern Medical Center, Dallas, Texas.