Pathomorphological evaluation of changes in the kidne; parenchyma after partial nephrectomy with high-level l light

Purpose: To assess morphological changes in the kidney parenchyma after laser-assisted partial nephrectomy and traditional partial nephrectomy. Materials and methods. Two groups of 50 Wistar rats were included into the experiment. Animals from the first group had laser-assisted partial nephrectomy without vessels clamping and without suturing the resected surface of the organ. Animals from the second group had traditional partial nephrectomy. High-level laser light with wavelength 970 nm and output power 4 W in continuous mode was used for laser-assisted partial nephrectomy. Animals from both groups were successively removed from the study. Morphological assessment of the kidney parenchyma following partial nephrectomy was done. Statistically significant difference (p < 0.05) between the two groups was found in 30 minutes and in 2, 7, 16 days after the surgery: necrosis thickness was less after laser-assisted intervention. In 40 days after the surgery, cicatrical tissue thickness in the resection margin was 0.41 ± 0.11 mm following laser-assisted partial nephrectomy, while it was 1.15 ± 0.16 mm after traditional partial nephrectomy, p < 0.05. There were no deep destructive changes in the kidney parenchyma after laser-assisted partial nephrectomy. The researchers also found that after laser-assisted surgery, inflammation in the kidney parenchyma was aseptic with the prevailing productive phase and with relatively early and active formation of the granulation tissue. Reactivation of microcirculation and reparation of kidney parenchyma in the resection margin started earlier after laser-assisted partial nephrectomy than after traditional partial nephrectomy.

лазерная резекция, высокоэнергетическое лазерное излучение, морфологические изменения, паренхима почки, laser-assisted partial nephrectomy, high-energy laser-emitting light, pathomorphological changes, kidney parenchyma

1. Гейниц А.В., Елисеенко В.И. Особенности взаимодействия излучения полупроводникового лазера с биологическими тканями // Матер. III Международ. семин. «Полупроводниковые и твердотельные лазеры в медицине 2000». - СПб., 2000. -С. 23-24

2. Елисеенко В.И. Патогенетические механизмы взаимодействия различных видов лазерного излучения с биологическими тканями // Лазеры в хирургии / Под ред. проф. О.К. Скобелкина. - М.: Медицина, 1989. - С. 44-57.

3. Елисеенко В.И. Патологическая анатомия и патогенез лазерной раны // Лазерная медицина. - 2017. - Т. 21. - Вып. 4. - С. 5-11.

4. Копасов Е.В. Резекция почки с помощью высокоинтенсивного лазерного излучения с пластикой ксеногенным материалом: Автореф. дис.. канд. мед. наук. - Челябинск, 2009. - 26 с.

5. Морозова Е.А., Елисеенко В.И., Давтян А.А., Корнильев М.Н. Патологическая анатомия и патогенез лазерной раны // Лазерная медицина. - 2017. - Т. Вып. 3. - С. 22-27.

6. Demirjian S., Lane B.R., Derweesh I.H. et al. Chronic kidney disease due to surgical removal of nephrons: relative rates of progression and survival // J. Urol. - 2014. - V. 192. - P. 1057-1063.

7. Khoder W.Y., Zilinberg K., Waidelich R. et al. Ex vivo comparison of the tissue effects of six laser wavelengths for potential use in laser supported partial nephrectomy // J. Biomed. Opt. 2012. - V. 17. - Is. 6. https://www.spiedigitallibrary.org/journals /Journal-of-Biomedical-0ptics/volume-17/issue-6/068005/ iEx-vivo-i-comparison-of-the-tissue-effects-of-six/10.1117/1. JB0.17.6.068005.short.

8. Khoder W.Y., Sroka R., Siegert S. et al. Outcome of laser-assisted laparoscopic partial nephrectomy without ischaemia for peripheral renal tumours // World J. Urol. - 2012. - V. 30. - Is. 5. - P. 633-638.

9. Knezevic N., Kulis T., Maric M. et al. Laparoscopic partial nephrectomy with diode laser: apromising technique // Photomed. Laser. Surg. - 2014. - V. 32. - P. 101-105.

10. Loertzer H., Strauss A., Ringert R.H. et al. Laser supported partial laparoscopic nephrectomy for renal cell carcinoma without ischaemia time // BMC Urology. - 2013. - P. 13-31.

11. Lotan Y., Gettman M.T., Lindberg G. et al. Laparoscopic partial nephrectomy using holmium laser in a porcine model // J. SLS. - 2004. - V. 8. - Is. 1. - P. 51-55.

12. Mari A., Antonelli A., Bertolo R. Predictive factors of overall and major postoperative complications after partial nephrectomy: Results from a multicenter prospective study (The RECORd 1 project) // Eur. J. Surg. Oncol. - 2017. - V. 43. - Is. 4. - P. 823-830.

13. Zhou X.F., Ding Z.S., Wang J.F. et al. Laparoscopic partial nephrectomy by diode laser with highly selective clamping of segmental renal arterial // Chin. Med. J. - 2015. - V. 128. - P. 2262-2264.