title: Is renal warm ischemia over 30 minutes during laparoscopic partial nephrectomy possible? One-year results of a prospective study.
abstract: OBJECTIVE
  To evaluate renal damage and impairment of renal function 1 yr after laparoscopic partial nephrectomy (LPN) with warm ischemia >30 min.
  
  
  METHODS
  From July 2004 to June 2005, 18 patients underwent LPN with warm ischemia time >30 min. Kidney damage markers (daily proteinuria and tubular enzymes) and renal function (serum creatinine, cystatin C, and creatinine clearances) were assessed on postoperative days 1 and 5 and at 12 mo. Glomerular filtration rate (GFR) was evaluated before surgery and at 3 mo. Renal scintigraphy was performed before the procedure, at 5 d and at 3 and 12 mo postoperatively. Statistical analysis was performed using the Student t test and logistic regression analysis.
  
  
  RESULTS
  In terms of kidney damage and renal function markers, the statistical analysis demonstrated that at 1 yr there was complete return to the normal range and no statistical difference between the values at the various time points. The GFR was not significantly different before and 3 mo after surgery. In terms of scintigraphy of the operated kidney, the values were 48.35+/-3.82% (40-50%) before the procedure, 36.88+/-8.42 (16-50%) on postoperative day 5 (p=0.0001), 40.56+/-8.96 (20-50%) at 3 mo (p=0.003), and 42.8+/-7.2% (20-50%) 1 yr after surgery (p=0.001).
  
  
  CONCLUSIONS
  Our results demonstrate that kidney damage occurs during LPN when warm ischemia is >30 min. This damage is only partially reversible and efforts should be made to keep warm ischemia within 30 min.
authors: Department of Urology, University of Turin, San Luigi Hospital, Orbassano Torino, Italy. porpiglia@libero.it
authors: Francesco
authors: F
authors: Porpiglia
authors: Julien
authors: J
authors: Renard
authors: Michele
authors: M
authors: Billia
authors: Francesca
authors: F
authors: Musso
authors: Alessandro
authors: A
authors: Volpe
authors: Rodolfo
authors: R
authors: Burruni
authors: Carlo
authors: C
authors: Terrone
authors: Loredana
authors: L
authors: Colla
authors: Giorgina
authors: G
authors: Piccoli
authors: Valerio
authors: V
authors: Podio
authors: Roberto Mario
authors: RM
authors: Scarpa
mesh_terms: D006801:Humans; D007511:Ischemia / Q000150:complications*; D007668:Kidney / Q000473:pathology*; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D011446:Prospective Studies