Abstract
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. 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. 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 -0.90 C/min. reaching a threshold temperature of 26.90 C, and medullary temperatures decreased at -0.90 C/min. reaching a temperature of 26.10 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. 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.
Highlights
For the treatment of small renal masses, nephron sparing surgery has been shown to provide long-term benefits compared to radical nephrectomy [1]
While cold ischemia is applied during open nephron sparing surgery, it is technically difficult to implement in laparoscopic and robotic approaches ibju | Renal Cooling to Minimize Ischemia due to difficulty in introducing and maintaining ice slurry via trocars [11]
Cortical temperatures decreased at -0.90 C/min. reaching a threshold temperature of 26.90 C, and medullary temperatures decreased at -0.90 C/min. reaching a temperature of 26.10 C over 600 seconds on average for combined data at high infusion rates with hilar clamping
Summary
For the treatment of small renal masses, nephron sparing surgery has been shown to provide long-term benefits compared to radical nephrectomy [1]. Partial nephrectomy has become the treatment of choice for patients with small, organ confined renal tumors [2,3]. Compared to open nephron-sparing surgery, laparoscopic and robotic assisted partial nephrectomy provides the additional benefits of decreased pain medication requirements, shorter hospital stay, more rapid return to full activity and improved cosmetic results [4] in addition to offering equal cancer control [5]. Renal hypothermia has been shown to decrease ischemia induced renal damage and minimize reperfusion injury, which occurs from renal hilar clamping [68]. Subsequent researchers have evaluated the cellular mechanisms by which renal hypothermia protects against serious long term renal damage [10]. While cold ischemia is applied during open nephron sparing surgery, it is technically difficult to implement in laparoscopic and robotic approaches ibju | Renal Cooling to Minimize Ischemia due to difficulty in introducing and maintaining ice slurry via trocars [11]
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