Laparoscopic Partial Nephrectomy in Cold Ischemia:: Renal Artery Perfusion

Janetschek, Günter; Abdelmaksoud, Alaa; Bagheri, Fariborz; Alzahrani, Hassan M.; Leeb, Karl; Gschwendtner, Manfred

doi:10.1097/01.ju.0000101040.13244.c4

Cited by 180 publications

(75 citation statements)

References 15 publications

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“…Four patients required intraoperative blood transfusion. Mean hospital stay was 8 days (range [6][7][8][9][10][11][12][13][14]. No urinary fistula or urinoma was observed.…”

Section: Resultsmentioning

confidence: 99%

“…13 Janetscheck et al in 2004 adopted balloon arterial catheters in the first two patients of their series. 9 However, since some arterial bleeding occurred in the second patient, they shifted to a tourniquet for arterial occlusion in the remaining patients. Consequently, angiocatheters without balloon tips were used , which provided only cold perfusion.…”

Section: Discussionmentioning

confidence: 99%

“…8 There are no reliable and effective methods for laparoscopic renal cooling that can match the results of renal cooling achieved with ice slush in open partial nephrectomy. Renal cooling through an angiographic catheter in renal artery, 9 ureteral catheter in the pelvicalyceal system, 10,11 with coil 12 or using ice slush in a laparoscopic bag 13 for laparoscopic partial nephectomies (LPN) were reported. The initial experience with renal arterial catheterization for temporary balloon occlusion and simultaneous hypothermic perfusion during LPN is reported.…”

Section: Introductionmentioning

confidence: 99%

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Balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy

Shen

Chueh²,

Lai³

et al. 2008

Int J of Urology

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Objectives: We describe our initial experience with renal arterial catheterization for temporary balloon occlusion of renal artery and hypothermic perfusion during laparoscopic partial nephectomy and compare the preoperative and postoperative nephron function. Methods: Fifteen patients received laparoscopic partial nephrectomy from September 2005 to December 2006. During the operations, the balloons of the arterial catheters were filled with distilled water to achieve pedicle control. Chilled Ringers lactate was continuously infused into the catheters for renal hypothermia. Postoperative Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal scintigraphies were carried out to estimate differential renal function. The volumes of the renal tumors, tumor-bearing and contralateral kidneys from CT scans were measured using commercial software. Estimated creatinine clearance was calculated with Cockroft Gault formula. Results: All procedures were successfully completed. Mean tumor size was 18.4 mL (range 2.14 to 59.0). Estimated mean intraoperative blood loss was 287 mL (range minimal to 1200). Mean estimated creatinine clearance per unit volume of functional renal parenchyma did not change statistically after the operation. Multiple regression analysis revealed that ischemic time was a significant variable which correlated with the value of lost total estimated creatinine clearance of the tumor bearing kidney. Conclusions:The initial experience shows that renal arterial catheterization for temporary balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy is safe, feasible and effective. The postoperative kidney function measured by mean estimated creatinine clearance per unit of functional renal volume was similar to the preoperative measurement.

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“…Four patients required intraoperative blood transfusion. Mean hospital stay was 8 days (range [6][7][8][9][10][11][12][13][14]. No urinary fistula or urinoma was observed.…”

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy

Shen

Chueh²,

Lai³

et al. 2008

Int J of Urology

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“…Regional hypothermia is often utilized when prolonged times are anticipated. Various methods have been studied to address this issue (12,14,15). At the Cleveland Clinic, regional hypothermia is employed with ice slush only when prolonged ischemic times are anticipated.…”

Section: Transperitoneal Approachmentioning

confidence: 99%

Laparoscopic partial nephrectomy for cancer: techniques and outcomes

et al. 2005

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Open partial nephrectomy is the gold standard nephron-sparing treatment for small renal tumors. Technical aspects of laparoscopic partial nephrectomy have evolved considerably, and the technique is approaching established status at our institution. Over the past 4 years, the senior author has performed more than 400 laparoscopic partial nephrectomies at the Cleveland Clinic. Herein we present our current technique and review contemporary outcome data.

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“…However, intraoperative assessment of kidney temperature during cooling and/or ischemia procedures are not routinely performed and poorly studied. Even when different renal cooling techniques are compared, whether in animals or humans, there is no standardization for such measurement (3)(4)(5)(6)(7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

Infrared Thermometer: an accurate tool for temperature measurement during renal surgery

et al. 2013

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Purpose: To evaluate infrared thermometer (IRT) accuracy compared to standard digital thermometer in measuring kidney temperature during arterial clamping with and without renal cooling. Materials and Methods: 20 pigs weighting 20Kg underwent selective right renal arterial clamping, 10 with (Group 1 -Cold Ischemia with ice slush) and 10 without renal cooling (Group 2 -Warm Ischemia). Arterial clamping was performed without venous clamping. Renal temperature was serially measured following clamping of the main renal artery with the IRT and a digital contact thermometer (DT): immediate after clamping (T0), after 2 (T2), 5 (T5) and 10 minutes (T10). Temperature values were expressed in mean, standard deviation and range for each thermometer. We used the T student test to compare means and considered p < 0.05 to be statistically significant. Results: In Group 1, mean DT surface temperature decrease was 12.6 ± 4.1ºC (5-19ºC) while deep DT temperature decrease was 15.8 ± 1.5ºC (15-18ºC). For the IRT, mean temperature decrease was 9.1 ± 3.8ºC (3-14ºC). There was no statistically significant difference between thermometers. In Group 2, surface temperature decrease for DT was 2.7 ± 1.8ºC (0-4ºC) and mean deep temperature decrease was 0.5 ± 1.0ºC (0-3ºC). For IRT, mean temperature decrease was 3.1 ± 1.9ºC (0-6ºC). No statistically significant difference between thermometers was found at any time point. Conclusions: IRT proved to be an accurate non-invasive precise device for renal temperature monitoring during kidney surgery. External ice slush cooling confirmed to be fast and effective at cooling the pig model.

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Laparoscopic Partial Nephrectomy in Cold Ischemia:: Renal Artery Perfusion

Cited by 180 publications

References 15 publications

Balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy

Balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy

Laparoscopic partial nephrectomy for cancer: techniques and outcomes

Infrared Thermometer: an accurate tool for temperature measurement during renal surgery

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