Advertisement

Renal Hypothermia Using Ice-cold Saline for Retroperitoneal Laparoscopic Partial Nephrectomy: Evaluation of Split Renal Function With Technetium-99m-Dimercaptosuccinic Acid Renal Scintigraphy

Published:February 18, 2011DOI:https://doi.org/10.1016/j.urology.2010.12.007

      Objectives

      To evaluate the changes in split renal function after retroperitoneal laparoscopic partial nephrectomy with renal hypothermia using ice-cold saline.

      Methods

      From June 2002 to October 2009, 32 patients (median age 56 years) underwent retroperitoneal laparoscopic partial nephrectomy with hypothermia using ice-cold saline for the treatment of small renal tumors. The total renal function was monitored using the estimated glomerular filtration rate. Split renal function was evaluated using technetium-99m dimercaptosuccinic acid renal scintigraphy preoperatively and 3 months postoperatively.

      Results

      The median renal ischemic time, including the initial 10 minutes for cooling, was 52 minutes (range 28-101). Of the patients whose renal temperature was monitored, the lowest renal temperature during cooling was 15-25°C. The median decrease in the estimated glomerular filtration rate was 7.2 mL/min/1.73 m2 (range −16.3 to 33.7). The median decrease in the contribution of the affected kidney to global renal function was 5.3% (range 0.4%-21.1%). On multivariate analysis, a shorter ischemia duration was an independent predictor of a lesser decrease in the contribution of the affected kidney (P = .0032).

      Conclusions

      The methods we have described are simple and effective to facilitate suboptimal hypothermia. The decrease in the renal contribution of the affected kidney appeared to be minimal, although the ischemic time was relatively longer in our series.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Urology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Campbell S.C.
        • Novick A.C.
        Expanding the indications for elective partial nephrectomy: is this advisable?.
        Eur Urol. 2006; 49: 952-954
        • Huang W.C.
        • Levey A.S.
        • Serio A.M.
        • et al.
        Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study.
        Lancet Oncol. 2006; 7: 735-740
        • Huang W.C.
        • Elkin E.B.
        • Levey A.S.
        • et al.
        Partial nephrectomy versus radical nephrectomy in patients with small renal tumors—is there a difference in mortality and cardiovascular outcomes?.
        J Urol. 2009; 181: 55-61
        • Weight C.J.
        • Larson B.T.
        • Fergany A.F.
        • et al.
        Nephrectomy induced chronic renal insufficiency is associated with increased risk of cardiovascular death and death from any cause in patients with localized cT1b renal masses.
        J Urol. 2010; 183: 1317-1323
        • Go A.S.
        • Chertow G.M.
        • Fan D.
        • et al.
        Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization.
        N Engl J Med. 2004; 351: 1296-1305
        • Becker F.
        • Van Poppel H.
        • Hakenberg O.W.
        • et al.
        Assessing the impact of ischaemia time during partial nephrectomy.
        Eur Urol. 2009; 56: 625-634
        • Porpiglia F.
        • Renard J.
        • Billia M.
        • et al.
        Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible?.
        Eur Urol. 2007; 52: 1170-1178
        • Gill I.S.
        • Abreu S.C.
        • Desai M.M.
        • et al.
        Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience.
        J Urol. 2003; 170: 52-56
        • Wakabayashi Y.
        • Narita M.
        • Kim C.J.
        Renal hypothermia using ice slush for retroperitoneal laparoscopic partial nephrectomy.
        Urology. 2004; 63: 773-775
        • Landman J.
        • Venkatesh R.
        • Lee D.
        • et al.
        Renal hypothermia achieved by retrograde endoscopic cold saline perfusion: technique and initial clinical application.
        Urology. 2003; 61: 1023-1025
        • Janetschek G.
        • Abdelmaksoud A.
        • Bagheri F.
        • et al.
        Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion.
        J Urol. 2004; 171: 68-71
        • Matsuo S.
        • Imai E.
        • Horio M.
        • et al.
        Collaborators developing the Japanese equation for estimated GFR: revised equations for estimated GFR from serum creatinine in Japan.
        Am J Kid Dis. 2009; 53: 982-992
        • Russo P.
        Partial nephrectomy for renal cancer (part II): the impact of renal ischaemia, patient preparation, surgical approaches, management of complications and utilization.
        BJU Int. 2010; 105: 1494-1507
        • Wickham J.E.A.
        • Hanley H.G.
        • Joekes A.M.
        Regional renal hypothermia.
        Br J Urol. 1969; 39: 727-743
        • Ward J.P.
        Determination of the optimum temperature for regional renal hypothermia during temporary renal ischaemia.
        Br J Urol. 1975; 47: 17-24
        • Marberger M.
        • Georgi M.
        • Guenther R.
        • et al.
        Simultaneous balloon occlusion of the renal artery and hypothermic perfusion in in situ surgery of the kidney.
        J Urol. 1978; 119: 463-467
        • Shikanov S.
        • Lifshitz D.
        • Chan A.A.
        • et al.
        Impact of ischemia on renal function after laparoscopic partial nephrectomy: a multicenter study.
        J Urol. 2010; 183: 1714-1718
        • Matsuda T.
        • Nakagawa M.
        • Oguchi N.
        • et al.
        Retroperitoneoscopic partial nephrectomy with transient occlusion of renal artery for treatment of small renal tumors.
        Urology. 2004; 64: 26-30
        • Kobayashi Y.
        • Usui Y.
        • Shima M.
        • et al.
        Evaluation of renal function after laparoscopic partial nephrectomy with renal scintigraphy using 99mtechnetium-mercaptoacetyltriglycine.
        Int J Urol. 2006; 13: 1371-1374
        • Tachikake O.
        • Shigeta M.
        • Mita K.
        • et al.
        Decrease of renal function due to warm ischemia after laparoscopic partial nephrectomy: evaluation using 99mTc-DMSA renal scintigraphy.
        Urol Int. 2009; 82: 162-165