title: Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion.
abstract: OBJECTIVE
  Laparoscopic partial nephrectomy represents a feasible option for patients with small renal masses. We describe our initial experience with laparoscopic partial nephrectomy in cold ischemia achieved by renal artery perfusion.
  
  
  METHODS
  From November 2001 to March 2003 laparoscopic partial nephrectomy in cold ischemia was performed in 15 patients with renal cell carcinoma. Cold ischemia was achieved by continuous perfusion of Ringers lactate at 4C through the renal artery, which was clamped. Tumor excision was performed in a bloodless field with biopsy taken from the tumor bed. The collecting system was repaired if needed. Renal reconstruction was performed by suturing over hemostatic bolsters.
  
  
  RESULTS
  All procedures were successfully completed laparoscopically by our new technique. Mean operative time was 185 minutes (range 135 to 220). Mean ischemia time was 40 minutes (range 27 to 101). Estimated mean intraoperative blood loss was 160 ml (range 30 to 650). Entry to the collecting system in 6 patients was repaired intraoperatively. Additional vascular repair was done in 2 patients. There were no significant postoperative complications. Postoperative followup in 8 patients showed that the renal parenchyma was not damaged by the ischemic period.
  
  
  CONCLUSIONS
  Our initial experience of incorporating cold ischemia via arterial perfusion into laparoscopic partial nephrectomy shows the feasibility and safety of the technique. We believe that this approach has the potential to make laparoscopic partial nephrectomy for renal cell carcinoma safe and reliable.
authors.affiliation: Department of Urology, Elisabethinen Hospital, Linz, Austria. guenter.janetchek@elisabethionen.or.at
authors.forename: Günter
authors.initials: G
authors.lastname: Janetschek
authors.forename: Alaa
authors.initials: A
authors.lastname: Abdelmaksoud
authors.forename: Fariborz
authors.initials: F
authors.lastname: Bagheri
authors.forename: Hassan
authors.initials: H
authors.lastname: Al-Zahrani
authors.forename: Karl
authors.initials: K
authors.lastname: Leeb
authors.forename: Manfred
authors.initials: M
authors.lastname: Gschwendtner
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000009:adverse effects / Q000379:methods*; D010477:Perfusion; D012077:Renal Artery