Novel technique for in situ cold perfusion in laparoscopic partial nephrectomy.
BACKGROUND
Following clamping of the renal hilus, warm ischemia is an issue in laparoscopic partial nephrectomy. If ischemia longer than 30 min is anticipated, special protective measures are needed. The aim of this study was to develop a solely laparoscopic technique for in situ cold perfusion of kidneys during laparoscopic partial nephrectomy to increase the tolerance of renal parenchyma to ischemic damage in a porcine model.


METHODS
Six animals were used in this study. We tried to develop a technique that allowed us to cannulate the renal artery, introduce a catheter to perform an in situ cold perfusion and-the most important feature-secure the catheter throughout the laparoscopic partial nephrectomy.


RESULTS
A modified laparoscopic vascular bulldog clamp was ultimately ideal to fulfil expectations. In five pigs, a successful partial nephrectomy in in situ perfusion was performed. The median warm ischemia time, starting from occlusion of the renal artery and vein to the commencement of cold perfusion, was 130 s (range 75-165 s). The subsequent median cold ischemia time in which a partial nephrectomy was simulated was 42 min (range 26-52 min).


CONCLUSIONS
The newly developed technique expands the armamentarium of the urologist in laparoscopic partial nephrectomy, if the anticipated time of ischemia exceeds 30 min and renal hypothermia is indicated.
Simon
Jörg
J
Department of Urology, University of Ulm, Prittwitzstr. 43, 89075 Ulm, Germany. joerg.simon@uniklinik-ulm.de
Meilinger
Michael
M
Lang
Herve
H
Hautmann
Richard E
RE
de Petriconi
Robert
R
D000818:Animals; D003080:Cold Temperature; D003250:Constriction; D004867:Equipment Design; D005240:Feasibility Studies; D010535:Laparoscopy / Q000379:methods*; D009392:Nephrectomy / Q000379:methods*; D010477:Perfusion; D013552:Swine