الفهرس 
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Abstract
Partial nephrectomy (PN) has become the standard method for treating T1 renal tumors. It achieves the preservation of the largest possible amount of functional renal parenchyma and reduces the incidence of acute and chronic renal failure after surgery in the short and long term, and the associated complications on metabolic and cardiovascular functions.
The main challenges affecting the outcome of this surgical technique is the need to temporarily cut off the blood supply to the kidney to assist in the complete excision of the tumor and to achieve good coagulation of the tumor bed. Therefore, achieving a balance between minimum ischemia time and bleeding that maintains clear vision, using a coagulation technique that achieves stable and rapid hemostasis is a critical point to achieve the best outcomes.
The use of suture renorrhaphy was and still is the standard method for achieving secure coagulation and safe healing at the tumor bed after resection. It can be used regardless of the size of the bleeding area, the size of the bleeding vessel, or the amount of bleeding. However, this technique consumes the precious ischemia time, and damages a non-negligible part of the functional renal tissue. Also it requires high surgical skills.
In this study, we used argon beam to achieve in situ coagulation after resection of the tumor from the kidney. Although this technique has many advantages - it improves visibility of the bleeding site and avoids the dissipation of effective energy in fluids - it was used to replace part but not all of the sutures used in the tumor site. The reason was to ensure a minimum standard of safety against the possibility of bleeding from tumor bed intra- or post-operative.
Argon beam coagulation has been tested as a mean of coagulation and healing on renal tissue in rats and rabbits and has not been extensively studied in humans so far. To test the efficiency of this technique, we randomly distributed 37 patients with clinically T1 renal tumors into two groups. All patients had laparoscopic PN. In the first group (G1) (argon coagulation + renorrhaphy) with the results of using renorrhaphy alone in the tumor bed by the traditional method (deep medullary layer and superficial cortical layer) in the second group (G2).
Operative and postoperative outcomes were recorded; including ischemia time, operative time, estimated blood loss, length of hospital stay, rate of complications and pain scales. The rate of positive surgical margin and the local recuurence. Glomerular filtration rate has been estimated (eGFR) at 0, 1-month, and 3-months post-PN. Urine levels of transforming growth factor beta 1 (TGFb1) were measured at 0, 1 and 30 days post-PN to indicate the fibrogenic process post-PN. Patients were followed for 3 months.