Cold intravascular organ perfusion for renal hypothermia during laparoscopic partial nephrectomy Journal Article
| Authors: | Marley, C. S.; Siegrist, T.; Kurta, J.; O'Brien, F.; Bernstein, M.; Solomon, S.; Coleman, J. A. |
| Article Title: | Cold intravascular organ perfusion for renal hypothermia during laparoscopic partial nephrectomy |
| Abstract: | Purpose: We report initial data on the safety and functional outcomes of renal hypothermia with arterial cold perfusion during partial nephrectomy. Materials and Methods: From June 2007 to June 2009, 31 consecutive patients underwent laparoscopic partial nephrectomy with hypothermia using renal arterial perfusion with cold, lactated Ringer's solution during renal ischemia. Doppler echography was done intraoperatively to evaluate renal perfusion. Complication data were reported prospectively. Median followup was 57 weeks (IQR 28, 83). Results: The lowest recorded renal temperature during ischemia was 14C. Median tumor size was 4.0 cm (IQR 2.7, 6.2). Median estimated blood loss was 150 cc (IQR 100, 275). Median ischemia time was 35 minutes (IQR 26, 41). Doppler echography identified intrarenal arterial blood flow postoperatively in all cases. The median change in the estimated glomerular filtration rate from preoperatively to postoperative day 2 was 4 ml per minute (IQR -29, 19). Two months postoperative in 20 patients the median change was 3.5 ml per minute (IQR -6, 16.5). At last followup in 31 patients the overall change in the estimated glomerular filtration rate was -0.5 ml per minute (IQR -6, 6). Six complications developed in a total of 5 patients, of which 5 were grade 2 or less. One grade 3 postoperative hemorrhage from an arteriovenous fistula at the tumor resection site was treated with angiography and selective embolization. Conclusions: Cold intravascular perfusion during laparoscopic partial nephrectomy can achieve renal hypothermia below 15C. It is not associated with an immediate risk of renal vascular injury or thrombosis, as measured by Doppler echography in this series. Early changes in postoperative estimates of renal function appear minimal. © 2011 American Urological Association Education and Research, Inc. |
| Keywords: | adult; clinical article; aged; antibiotic agent; antibiotic therapy; cancer surgery; postoperative period; artificial embolism; outcome assessment; follow up; laparoscopy; laparoscopic surgery; tumor volume; bleeding; doppler echography; nephrectomy; kidney; partial nephrectomy; preoperative period; kidney tumor; kidney ischemia; urine incontinence; patient safety; ringer lactate solution; postoperative infection; glomerulus filtration rate; hospital readmission; postoperative hemorrhage; hypothermia; induced hypothermia; solitary kidney; perfusion; kidney blood flow; artery blood flow; body temperature; cold intravascular kidney perfusion; kidney angiography; kidney arteriovenous fistula; kidney perfusion; peroperative echography; urinoma |
| Journal Title: | Journal of Urology |
| Volume: | 185 |
| Issue: | 6 |
| ISSN: | 0022-5347 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2011-06-01 |
| Start Page: | 2191 |
| End Page: | 2195 |
| Language: | English |
| DOI: | 10.1016/j.juro.2011.02.013 |
| PROVIDER: | scopus |
| PUBMED: | 21497840 |
| DOI/URL: | |
| Notes: | --- - "Export Date: 23 June 2011" - "CODEN: JOURA" - "Source: Scopus" |
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