Zero Ischemia Anatomical Partial Nephrectomy: A Novel Approach

Gill, Inderbir S.; Patil, Mukul; Abreu, André Luís de Castro; Ng, Casey K.; Cai, Jie; Berger, André; Eisenberg, Manuel S.; Nakamoto, Masahiko; Ukimura, Osamu; Goh, Alvin C.; Thangathurai, Duraiyah; Aron, Monish; Desai, Mihir

doi:10.1016/j.juro.2011.10.146

Cited by 196 publications

(131 citation statements)

References 12 publications

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“…20 Outcomes were favourable with a mean absolute and percentage change in preoperative and 4-month postoperative eGFR of -11.4 mL/min/1.73 m 2 and 13%, respectively. Nonetheless, this technique is technically demanding and requires a steep learning curve.…”

Section: Road To Zero Ischaemiamentioning

confidence: 91%

Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

Cheng

Yiu

et al. 2016

Hong Kong Med J

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Section: Road To Zero Ischaemiamentioning

confidence: 91%

Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

Cheng

Yiu

et al. 2016

Hong Kong Med J

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“…18 Several technically challenging nonclamping approaches have been recently proposed to avoid renal ischemia, with significantly higher complication rates. 19,20 Using open partial nephrectomy for excision of a renal mass involving direct clamp occlusion of the renal blood vessels, we have conducted a prospective study that evaluates for the first time the structural response of the human kidney to clamp ischemia and initial reperfusion in association with assessment of short-term renal functional outcomes and novel biomarkers. Our results document substantial resistance of the human kidney to clamp ischemia and have implications for both the basic understanding of ischemic injury in human kidneys and the care of patients requiring isolated controlled ischemia for partial nephrectomy and other procedures.…”

mentioning

confidence: 99%

Tolerance of the Human Kidney to Isolated Controlled Ischemia

Parekh¹,

Weinberg²,

Ercole

et al. 2013

Journal of the American Society of Nephrology

178

146

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Tolerance of the human kidney to ischemia is controversial. Here, we prospectively studied the renal response to clamp ischemia and reperfusion in humans, including changes in putative biomarkers of AKI. We performed renal biopsies before, during, and after surgically induced renal clamp ischemia in 40 patients undergoing partial nephrectomy. Ischemia duration was .30 minutes in 82.5% of patients. There was a mild, transient increase in serum creatinine, but serum cystatin C remained stable. Renal functional changes did not correlate with ischemia duration. Renal structural changes were much less severe than observed in animal models that used similar durations of ischemia. Other biomarkers were only mildly elevated and did not correlate with renal function or ischemia duration. In summary, these data suggest that human kidneys can safely tolerate 30-60 minutes of controlled clamp ischemia with only mild structural changes and no acute functional loss.

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“…If available within the laparoscopic or robotic camera it could be used for testing of new cooling techniques with the advantage of being a non-contact device as already discussed. Moreover, with the advances in nephron-sparing surgery and trend towards very selective clamping (22), the IRT could be used to define the area without blood flow after the desired branch of renal artery was occluded during partial nephrectomy procedures just by establishing temperature differences.…”

Section: Discussionmentioning

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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Zero Ischemia Anatomical Partial Nephrectomy: A Novel Approach

Cited by 196 publications

References 12 publications

Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

Initial results of selective renal parenchymal clamping with an adjustable kidney clamp in nephron-sparing surgery: an easy way to minimise renal ischaemia

Tolerance of the Human Kidney to Isolated Controlled Ischemia

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

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