Renal hypothermia achieved by retrograde endoscopic cold saline perfusion: technique and initial clinical application

Landman, Jaime; Venkatesh, Ramakrishna; Lee, David I.; Vanlangendonck, Richard; Morissey, Kevin; Andriole, Gerald L.; Clayman, Ralph V.; Sundaram, Chandru P.

doi:10.1016/s0090-4295(02)02566-9

Cited by 120 publications

(39 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…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%

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

Shen

Chueh²,

Lai³

et al. 2008

Int J of Urology

View full text Add to dashboard Cite

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.

show abstract

“…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%

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

Shen

Chueh²,

Lai³

et al. 2008

Int J of Urology

View full text Add to dashboard Cite

show abstract

“…Previous authors have described various methods of renal cooling during laparoscopic partial nephrectomy, including intraoperative peri-renal ice slush (12) or cool saline irrigation (13)(14)(15)(16)(17)(18)(19), arterial infusion of cooled saline (22,23). When employed, authors found a decreased in ischemic nephron damage following renal vessel clamping in animal and/or human subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Using a ureteral access sheath, ice cold saline was infused to cool the kidney from the collecting system outward to the cortex (18). Further attempts to refine the technique utilized a different ureteral catheters (19). While previous studies have demonstrated the feasibility of retrograde renal hypothermia, potential complications and limited data concerning technical considerations have limited its application clinically (20).…”

Section: Introductionmentioning

confidence: 99%

Retrograde Renal Cooling to Minimize Ischemia

et al. 2013

View full text Add to dashboard Cite

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.

show abstract

“…Several authors have described techniques to achieve renal cooling during LPN, but many of the approaches described to date, such as laparoscopic ice slush, intra-arterial cold saline perfusion, and retrograde endoscopic cold saline perfusion, remain challenging or cumbersome to implement and are not widely used clinically. [55][56][57] The studies with these renal hypothermia techniques during LPN, however, have demonstrated comparable functional outcomes to those studies with acceptable WIT. A retrospective study with 71 patients with renal hypothermia induced by ice-slush cooling demonstrated comparable median postoperative eGFR decrease of 8.9 mL/min/1.73 m 2 6 months postoperatively with median cold ischemic time of 57 minutes (including initial 15 minutes of hypothermia), which is substantially longer than that of other warm ischemic series.…”

Section: A Note On Warm Ischemia During Lpnmentioning

confidence: 94%

Laparoscopic partial nephrectomy: state of the art review

Faiena¹,

Han²,

Olweny³

2014

OAS

View full text Add to dashboard Cite

Introduction:The surgical management of small renal masses (,4 cm) has greatly evolved over the last few decades, with the paradigm shifting from radical to partial nephrectomy. Laparoscopic partial nephrectomy (LPN) is increasingly utilized, and has achieved similar outcomes to open partial nephrectomy with decreased patient morbidity in experienced hands. The aim of this review was to examine the current status and future direction of LPN. Materials and methods:We performed a nonsystematic review of the literature using a free-text protocol in the PubMed database, using the terms "laparoscopic partial nephrectomy", "robotassisted partial nephrectomy", "robotic partial nephrectomy", and "laparoscopic partial nephrectomy oncologic and functional outcomes". Only English language articles were selected. Evidence synthesis: Our search results yielded 1,136. Three authors reviewed the results, and articles with information on patient and tumor selection, surgical techniques, and oncologic and functional outcomes were included. With regard to outcomes, only series with the largest cohorts and longest follow-up were selected. Conclusion: LPN has evolved rapidly over the past 2 decades, and advances in technique as well as innovations in surgical technologies have facilitated its increased adoption in urologic practice. However, limitations remain, such as inadequacy of techniques to achieve cold ischemia laparoscopically, high technical demands of intracorporeal suturing, and limited ability to assess surgical anatomy beyond the field of view. These comprise goals of research aimed at improving future surgical precision and outcomes, while further decreasing the invasiveness of LPN.

show abstract

Renal hypothermia achieved by retrograde endoscopic cold saline perfusion: technique and initial clinical application

Cited by 120 publications

References 13 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

Retrograde Renal Cooling to Minimize Ischemia

Laparoscopic partial nephrectomy: state of the art review

Contact Info

Product

Resources

About