Argon plasma coagulation (APC) for endo-urological procedures: ex-vivo evaluations of hemostatic properties.

Abstract

Argon plasma coagulation (APC) is an innovative therapeutic modality of non-contact electrocoagulation, which applies high-frequency current via ionized argon plasma. After several years of successful use in open surgery, endoscopic techniques have been established in various surgical fields. The aim of this study was to evaluate the hemostatic properties of this technique in a fluid medium with regard to endourological procedures. Isolated blood-perfused porcine kidneys were used to determine hemostatic efficacy of APC following TURP-like tissue ablation with a conventional loop electrode, compared to standard electrocoagulation with a ball electrode after tissue resection. Blood loss was quantified, specimens were evaluated histologically for coagulation zones. APC following tissue resection significantly (p<0.001) reduced bleeding compared to conventional contact electrocoagulation subsequent to tissue resection for an ablation volume of 4 cm(3) of perfused kidney tissue (2.1 ml/min vs. 5.6 ml/min). The depths of the coagulation zones were significantly larger (2.4 mm vs. 0.8 mm) and remarkably uniform for the groups treated with APC following tissue resection. APC performed in a fluid medium is feasible. APC following conventional TURP-like tissue resection creates significantly better hemostasis compared to standard contact coagulation after tissue resection. These findings justify further investigations to elucidate the value of APC in endourological procedures.