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Laparoscopic treatment developed for resistant hypertension

Hit : 370 Date : 2020-03-24

A group of physicians has presented a new therapy for resistant hypertension, which internal medicine had felt limitations in treating.

The researchers said in a recent report that they developed a novel renal denervation system through laparoscopic surgery to lower the blood pressure.

The three experts, who formed a multidisciplinary research team with Osong Medical Innovation Foundation, were Professor Jeong Chang-wook of the Department of Urology at Seoul National University Hospital, Professor Choi Eui-keun of the Department of Internal Medicine at the same school, and Professor Park Sung-min of the Creative IT Engineering Department at POSTECH.

From left, Professor Jeong Chang-wook of the Department of Urology at Seoul National University Hospital, Professor Choi Eui-keun of the Department of Internal Medicine at the same university, and Professor Park Sung-min of POSTECH’s Creative IT Engineering Department (Credit: Seoul National University Hospital)

About 40 percent of adults worldwide suffer high blood pressure, and 10 million of them die annually. Some 10 percent of hypertensive patients have resistant hypertension and do not react to three or more anti-hypertensive drugs. Most of them die from severe complications such as stroke and cardiovascular disease.

The research team paid attention to the fact that blocking the sympathetic nerves of the kidneys could lower blood pressure. In the past, researchers tried to block the sympathetic nerve passing through the outer wall of the renal artery by inserting a catheter into the blood vessel but failed. No study in the world was successful in progressing further from a phase-3 trial.

The Korean research team said it found the limitations of the conventional catheter-based renal denervation (RDN). About half of resistant hypertension patients have small arteries of 3 millimeters or less where a catheter does not go in. Also, about 30 percent of the sympathetic nerves are far from the renal arteries. This means that a catheter inside a blood vessel cannot wholly block nerves that exist outside.

The research team developed a new laparoscopic RDN system, which could completely block all the nerves, regardless of the position variants of patients’ blood vessels and nerves. The smart technique wraps the renal artery 360 degrees and delivers electronic energy at a steady temperature to the nerves.

The research team used four pigs to perform seven laparoscopic RDN surgery on the pigs’ both kidneys and confirmed that the new method effectively blocked the nerves. Pigs and humans have very similar kidney sizes and locations, the team said.

Although the newly developed method is still in the technical verification stage in animal experiments, it will be a useful technique soon, it added.

“The difference in blood pressure between the treatment group and the control group was very dramatic in continued animal studies and long-term animal survival studies since the initial study,” Professor Jeong said. “No research has reported such a successful result.”

Professor Choi said the new technique blocking the renal nerves would bring a significant change in hypertension and arrhythmia treatment, anticipating for more animal tests and clinical studies.

Professor Park said, “Overcoming limitations of conventional internal medicine with the help of minimally invasive surgery and advanced technology was a monumental success. It was a good example of multidisciplinary collaborative research.”

The study was part of the Korea Health Industry Development Institute’s R&D project to overcome diseases. It was also selected as the cover paper of the recent issue of the Investigative and Clinical Urology.

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