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Description of Technique and Initial Results: The Habib^Tm 4x Bipolar Resection Device In Open Nephron Sparing Surgery Without Renal Artery Occlusion
Gjanje L. Smith*, Ralph M. Zagha*, John A. Libertino*
Lahey Clinic, Burlington, MA

Introduction:
Even with the popularization of laparoscopy, open nephron sparing surgery (NSS) remains the gold standard for complex tumors. Efforts to reduce morbidity during NSSs are ongoing. The Habib^TM 4X bipolar resection device uses radiofrequency energy to coagulate the margin before sharp dissection. It has been used in liver resection. We present the first report of the Habib^TM in renal surgery.
Methods:
From February 2006 to March 2007, 35 patients underwent NSS without vascular clamping or compression via a supra-11^th rib incision (median age 58 years, tumor size 3.5 cm, preoperative hematocrit 41.9, creatinine 0.9). The resection line was scored with monopolar electrocautery. The Habib^TM was used to coagulate circumferentially around the mass to a depth of 0.5 - 1 cm before sharp dissection. It was not used near the collecting system, hilum or tumor base. Hemostasis at the resection bed was achieved with suture ligature/Floseal^®. Ureteral stents were placed for collecting system entry.
Results:
The median operative time was 188 minutes, median blood loss 300 cc (transfusion rate 31%), postoperative hematocrit 32.9, creatinine 1. Seventeen patients required ureteral stents. Complications included three transient urine leaks and one pneumonia. All margins were negative (31 RCC, 3 oncocytoma, 1 hamartoma). One patient with collecting system involvement recurred at 6 months.
Conclusions:
The Habib^TM is easily and effectively used for complex NSS. Comparison to a previous series of 86 consecutive NSSs indicates decreased operative time, blood loss and transfusion rate (median 280 min, 500 cc and 33.7% previously). Further investigation is needed.

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