Retrograde Renal Cooling to Minimize Ischemia

Abstract

Objective: During partial nephrectomy, renal hypothermia has been shown to decrease ischemia induced renal damage which occurs from renal hilar clamping. In this study we investigate the infusion rate required to safely cool the entire renal unit in a porcine model using retrograde irrigation of iced saline via dual-lumen ureteral catheter. Materials and Methods: Renal cortical, renal medullary, bowel and rectal temperatures during retrograde cooling in a laparoscopic porcine model were monitored in six renal units. Iced normal saline was infused at 300 cc/hour, 600 cc/hour, 1000 cc/hour and gravity (800 cc/hour) for 600 seconds with and without hilar clamping. Results: Retrograde cooling with hilar clamping provided rapid medullary renal cooling and significant hypothermia of the medulla and cortex at infusion rates ≥ 600 cc/hour. With hilar clamping, cortical temperatures decreased at -0.9 0 C/min. reaching a threshold temperature of 26.9 0 C, and medullary temperatures decreased at -0.90 C/min. reaching a temperature of 26.1 0 C over 600 seconds on average for combined data at infusion rates ≥ 600 cc/hour. The lowest renal temperatures were achieved with gravity infusion. Without renal hilum clamping, retrograde cooling was minimal at all infusion rates. Conclusions: Significant renal cooling by gravity infusion of iced cold saline via a duel lumen catheter with a clamped renal hilum was achieved in a porcine model. Continuous retrograde irrigation with iced saline via a two way ureteral catheter may be an effective method to induce renal hypothermia in patients undergoing robotic assisted and/or laparoscopic partial nephrectomy.

Cold saline irrigation, a novel approach, reduces the risk of postoperative urinary tract infection in retrograde intrarenal surgery

“…Ice is often placed around the kidney to cool it; however, there have also been reports of attempts to cool the kidney with retrograde intrarenal irrigation at some centers. [10,11] Postoperative UTI in RIRS is a condition that often results in septic shock caused by the retrograde entry of bacteria and endotoxins from the renal pelvis into the bloodstream as a result of increased intrarenal pressure. Our method is based on the hypothesis that cooling the renal medulla and constricting the blood vessels may inhibit the back ow of toxins into the blood.…”

A Comprehensive Overview of Innovative Approaches to Prevent Kidney Ischemia-Reperfusion Injury: Bibliometric and In Silico Analyses

“…The method of local cooling of the kidney by continuous retrograde perfusion of a cold solution through a cannulated ureter is a novel approach [52,53]. This cooling technique allows the operating field to remain "dry", which is not observed with renal surface irrigation with a cold solution or covering the kidney with an icy slush.…”

Robotic cold ischemia achieves comparable functional outcomes to open cold ischemia during partial nephrectomy for complex kidney tumors

“…Since then, additional methods for renal intracorporeal cooling have been described including retrograde ice-cold fluid injection through a ureteral catheter and renal artery infusion. [ 4 5 6 7 8 9 10 ] Recently, a robotic technique was defined which required a large midline incision, expensive gel port, and a custom-made ice plunger. [ 11 ]…”