Comparison of Tissue Oxygenation Profiles Using 3 Different Methods of Vascular Control During Porcine Partial Nephrectomy

Raman, Jay D.; Bensalah, Karim; Bagrodia, Aditya; Tracy, Chad R.; Kabbani, Wareef; Sagalowsky, Arthur I.; Cadeddu, Jeffrey A.

doi:10.1016/j.urology.2009.05.018

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Volume 74, Issue 4 , Pages 926-931, October 2009

Comparison of Tissue Oxygenation Profiles Using 3 Different Methods of Vascular Control During Porcine Partial Nephrectomy

Jay D. Raman
- Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
- Reprint requests: Jay D. Raman, M.D., Division of Urology, Penn State Milton S. Hershey Medical Center, 500 University Drive, C4830B, Hershey, PA 17033
Karim Bensalah
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
Aditya Bagrodia
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
Chad R. Tracy
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
Wareef Kabbani
- Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas
Arthur I. Sagalowsky
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas
Jeffrey A. Cadeddu
- Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas

Received 26 March 2009; accepted 11 May 2009. published online 22 July 2009.

Objectives

To compare oxygenation profiles and renal function outcomes between 3 methods of vascular control during porcine partial nephrectomy.

Methods

To create a solitary kidney model, 18 pigs were subjected to a laparoscopic nephrectomy. Following a 7-day recovery, a contralateral open partial nephrectomy was performed with vascular control by either total renal artery clamping (TRAC, n = 6), partial renal artery clamping (PRAC, n = 6), or selective renal parenchymal clamping (SRPC, n = 6). Renal partial oxygen pressure (rPO₂) was monitored using a Licox probe. Serum creatinine was assessed on day 0 and postoperative days 3 and 7. Pigs were sacrificed on the seventh day and the kidney sent for pathological examination.

Results

Intraoperative oxygenation profiles demonstrated a lower percentage decline (P = .01), longer interval to nadir (P = .04), improved percentage recovery of baseline rPO₂ (P = .04), and a shorter duration to recover baseline rPO₂ (P = .03) in the PRAC and SRPC groups than in the TRAC. Despite not occluding the renal vasculature, the SRPC group experienced declines in rPO₂ profiles of almost 50% from baseline. Serum creatinine levels increased significantly more in the TRAC group at days 3 and 7 (P = .04 and .01, respectively). Histological examination demonstrated patchy inflammation of parenchyma in all groups.

Conclusions

The rPO₂ monitoring may provide a novel means to allow real-time assessment and titration of kidney perfusion during partial nephrectomy. PRAC and SRPC demonstrate favorable renal oxygenation profiles compared with TRAC. Interestingly, SRPC kidneys experienced a significant decline in tissue oxygenation profiles. Further work is necessary to better delineate the mechanism underlying this decline.