Clinical research of retroperitoneal laparoscopic partial nephrectomy with hypothermic renal artery perfusion in situ

Abstract

Objective To establish a new retroperitoneal laparoscopic technique which can keep the kidney in cold ischemia and has the characteristics of safety,effective and simplicity.Methods Twenty-two patients who needs to do the retroperitoneal laparoscopic partial nephrectomy were divided into two groups:the research group and the control group.There were 12 males and 10 females with average age of 37-69 years old.There were 4 cases of angiomyolipoma,and 18 cases of renal cell carcinoma.In research group,the renal temperature was reduced by circumfusion system of ice saline after clamping the renal artery,and then the retroperitoneal laparoscopic partial nephrectomy was done.In the control group,we did the same as well except the renal hypothermia.The renal temperature and the rectal temperature during the surgery,and the glomerular filtration rate (GFR) of both bilateral kidneys and the affected kidney before and after the surgery were compared.Results All the surgical operations were done successfully in both groups.No post-operative bleeding,inflammation and leakage of urine occurred.In the research group,the average cold ischemia time was (47.2 ±3.8) min,the average minimum renal temperature was (17.73 ± 0.91),and the average time reducing the renal temperature to 25 ℃ was (4.6 ±0.4) min.In the control group,the average cold ischemia time was (27.8 ± 1.5) min,and the average minimum renal temperature was (38.08 ± 0.33)℃.In the research group,the average GFR of the bilateral kidneys and the affected kidneys was (66.24 ±3.98) and (30.57 ±4.07) ml/min one week before the surgery,that was 53.89 ±7.53 and (20.92 ±4.49) ml/min one month after the surgery,that was (54.49 ±7.92) and (21.63 ±5.21) ml/min 3 months after the surgery,and that was (54.77 ± 7.84) and (21.73 ± 9.99) ml/min 6 months after the surgery,respectively.In the control group,the average GFR of th bilateral kidneys and the affected kidney was 66.49 ±9.87 and (30.65 ±5.45) ml/min one week before the surgery,that was (54.89 ±9.61) and (17.90 ±3.50) ml/min one month after surgery,that was (55.68 ± 10.02) and (18.09 ±3.39) ml/min 3 months after the surgery,and that was 55.82 ±5.12 and (18.17 ±3.39) ml/min 6 months after the surgery,respectively.The follow-up duration was 1-16 months without local recurrence and metastasis.Conclusion The new equipment with circumfusion system of ice saline can keep the kidney in cold ischemia,and is easy-to-use and efficient,especially it doesn' t need special equipment so it can be widely used in retroperitoneal laparoscopic surgery. Key words: Laparoscopy ; Partial nephretomy; Cold ischemia