Novel laser achieved tract hemostasis in tubeless percutaneous nephrolithotomy: Study
China: To obtain tract hemostasis in tubeless percutaneous nephrolithotomy (PNL), a 1470 nm laser seems a safe, effective, and feasible method, says a study published in BMC Urology.
The researcher's team from China wrote in their study, "we demonstrated a novel and effective method to obtain tract hemostasis in tubeless PNL using the 1470 nm laser, with a shorter hospital stay and less blood loss.
Tubeless PNL has been performed since the 1970s for the treatment of kidney and upper ureteral stones and has rapidly evolved as a popular operative approach over time. In patients with tract bleeding, performing tubeless percutaneous nephrolithotomy seems challenging. Considering this, Youjun Duan, University of South China, Hengyang, Hunan, People's Republic of China, and colleagues aimed to investigate the safety and efficacy of the 1470 nm laser for hemostatic completion in tubeless PNL patients with tract bleeding.
For this purpose, the researchers retrospectively included 120 patients between January 2020 and October 2021 and divided them into two groups. The hemostasis group included 60 patients receiving tubeless PNL, in which a 1470 nm laser was used to manage tract bleeding. The second group, which served as the control group included 60 patients receiving tubeless PNL in which the hemostasis procedure was not performed. The researchers statistically compared the differences in the patient's demographic characteristics, procedural information, and posttreatment outcomes between the two groups.
Based on the study, they found that:
· The differences associated with sex, age, weight, body mass index, urine culture, stone burden, calyx of puncture, degree of hydronephrosis, and comorbidities between the two groups were not statistically significant.
· Compared with the control group, the hemostasis group showed greatly reduced blood loss (0.61 ± 0.31 vs. 0.85 ± 0.46 g/dL) and decreased postoperative hospitalization duration (2.83 ± 0.81 vs. 4.45 ± 0.91 days).
· The differences in operative time, stone-free rate, Visual Analogue Score, and postoperative complications between the two groups were not statistically significant.
· In the subgroup analysis, the obese patients and patients with moderate to severe hydronephrosis in the hemostasis group also showed significantly less blood loss (0.51 ± 0.22 vs. 0.83 ± 0.48 g/dL; 0.54 ± 0.27 vs. 0.85 ± 0.47 g/dL, respectively) and shorter length of postoperative hospitalization (2.62 ± 0.51 vs. 4.47 ± 1.19 days; 2.97 ± 0.63 vs. 4.41 ± 0.91 days, respectively) than those in the control group.
The researchers concluded, "in terms of good effects and mild complications (Clavien-Dindo grade I or II), the current study showed that the 1470 nm laser is a novel, safe, and efficient technology for hemostasis of the nephrostomy tract in tubeless PNL."
Reference:
Zhang, H., Xu, H., Fei, K. et al. The safety and efficiency of a 1470 nm laser in obtaining tract hemostasis in tubeless percutaneous nephrolithotomy: a retrospective cross-sectional study. BMC Urol 22, 94 (2022). https://doi.org/10.1186/s12894-022-01046-z
