Habib laparoscopic bipolar radiofrequency device: A novel way of creating an avascular resection margin in laparoscopic partial nephrectomy

Introduction: Hemostasis during the laparoscopic partial nephrectomy (LPN) is a challenge. Usually, the renal hilum is clamped to minimize blood loss. However, prolonged ischemia leads to irreversible damage. Therefore, new technology is needed to minimize blood loss while performing LPN without hilar clamping. The Habib 4× Laparoscopic device (Angio Dynamics, Queensbury, NY) is a four-pronged bipolar radiofrequency probe that is proven to reduce blood loss in laparoscopic liver resections without hilar clamping. The aim of this pilot study was to evaluate this new technology in LPN. Methods: Three patients, with exophytic renal lesions (1.1-4 cm), underwent LPN without hilar clamping, using the Habib Laparoscopic device to create an avascular resection margin. Results: Mean operative time was 150.3 minutes, mean estimated blood loss was 100 cc, and none of the patients required transfusions. There was no significant difference between the mean pre- and postoperative serum creatinine levels (P > 0.05). All 3 resected masses were renal-cell carcinomas. Intraoperative frozen sections demonstrated negative margins in all cases. However, in the second case, with a renal lesion of 4 cm, the permanent section analysis on margins was read as focally positive. There were no complications. On follow-up imaging of up to 12 months, there were no recurrences. Conclusions: The Habib 4× Laparoscopic device permits the resection of exophytic renal lesions without the need for hilar clamping. However, a cautery artifact can cause difficulty in interpreting the frozen-section analysis of resection margins. Therefore, its use should be restricted to lesions of less than 2 cm.