Histological Evaluation Of Cold Versus Hot Cutting: Clinical Impact On Margin Status For Laparoscopic Partial Nephrectomy

Main Category: Urology / Nephrology
Article Date: 11 Feb 2009 - 2:00 PDT

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UroToday.com - One of the most important aspects of performing a partial nephrectomy is achieving a hemostatically secure renal bed. As such, one would like to incise the renal parenchyma with an instrument that would both cut and seal vessels; however, if this is done with common monopolar electrosurgical devices then the margin of the specimen becomes "unreadable" due to the induced char. However, newer laparoscopic instruments employ either an instrument gated bipolar or ultrasonic energy to cut and coagulate. Do these instruments result in an "unreadable" margin? The short answer is No!

In this article, both bipolar (10 cases) and ultrasonic (20 cases) excision of a renal mass resulted in a surgical margin that could be read as easily as a margin produced by a cold scissors (10 cases). Pathological assessment of margin fragmentation as well as artifact was similar for a cold cut and bipolar incision, while it was statistically significantly greater than a cold cut for the ultrasonic energy. However, the ability of the pathologist to accurately identify cells of a benign or malignant nature at the margin was not compromised by either form of energy. The one drawback to this approach is that it does result in a longer period of time to excise a given renal lesion.

Phillips JM, Narula N, Deane LA, Box GN, Lee HJ, Ornstein DK, McDougall EM, Clayman RV
J Urol. 2008 Dec;180(6):2348-52.
doi:10.1016/j.juro.2008.08.029

Written by UroToday.com Medical Editor Ralph V. Clayman, MD

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