Abstract
BackgroundStandard methods for assessment of organ viability during surgery are typically limited to visual cues and tactile feedback in open surgery. However, during laparoscopic surgery, these processes are impaired. This is of particular relevance during laparoscopic renal donation, where the condition of the kidney must be optimized despite considerable manipulation. However, there is no in vivo methodology to monitor renal parenchymal oxygenation during laparoscopic surgery.MethodsWe have developed a method for the real time, in vivo, whole organ assessment of tissue oxygenation during laparoscopic nephrectomy to convey meaningful biological data to the surgeon during laparoscopic surgery. We apply the 3-CCD (charge coupled device) camera to monitor qualitatively renal parenchymal oxygenation with potential real-time video capability.ResultsWe have validated this methodology in a porcine model across a range of hypoxic conditions, and have then applied the method during clinical laparoscopic donor nephrectomies during clinically relevant pneumoperitoneum. 3-CCD image enhancement produces mean region of interest (ROI) intensity values that can be directly correlated with blood oxygen saturation measurements (R2 > 0.96). The calculated mean ROI intensity values obtained at the beginning of the laparoscopic nephrectomy do not differ significantly from mean ROI intensity values calculated immediately before kidney removal (p > 0.05).ConclusionHere, using the 3-CCD camera, we qualitatively monitor tissue oxygenation. This means of assessing intraoperative tissue oxygenation may be a useful method to avoid unintended ischemic injury during laparoscopic surgery. Preliminary results indicate that no significant changes in renal oxygenation occur as a result of pneumoperitoneum.
Highlights
Standard methods for assessment of organ viability during surgery are typically limited to visual cues and tactile feedback in open surgery
Each venous blood draw (BD) is marked by a small increase in pO2; as the blood is drawn from the renal vein, fresh blood flows from the renal artery into the kidney, creating a temporary increase in tissue oxygenation
We chose the open porcine model so that pneumoperitoneum would not be a variable when considering the effect of blood oxygenation on the mean region of interest (ROI) values calculated from the 3-CCD camera
Summary
Standard methods for assessment of organ viability during surgery are typically limited to visual cues and tactile feedback in open surgery. Disadvantages of laparoscopic surgery include slightly longer warm ischemic times, and increased incidences of delayed graft function, the later thought to be the result of tissue hypoxia from pneumoperitoneum associated hypoperfusion and organ manipulation [1,2] These issues, while minor in most donors, are increasingly problematic in situations utilizing older donors, or organs intended for use in very small children [3,4]. The ability to intraoperatively monitor renal paranchyemal oxygenation would be useful in a number of clinical situations in which prompt resolution may have a dramatic effect One such an example is encountered when during the course of the operation the blood supply to the organ becomes impaired by the technical manuevers done during dissection (i.e., approaching the vessels from the posterior aspect). Other examples include the determination of secondary renal arteries and the establishment of a baseline acceptable pneumoperiotenum, potentially useful in older donors
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