Minimally invasive versus traditional chest surgical approach in patients with reduced renal function.
OBJECTIVE
All surgical access approaches to the chest wall cause a different degree of muscle damage and freeing of substances as myogloblin into the bloodstream thus compromising kidney function. The aim of this study was to evaluate the potential kidney damage in relation to entity of muscle lesions caused by the different surgical approaches.


METHODS
The hematic levels of creatine phosphokinase (CPK), myoglobin, lactate dehydrogenase (LDH), creatinine as well as the amount of the diuresis at different intervals of time were taken of 66 patients who underwent a thoracic surgical operation with diverse surgical access approaches.


RESULTS
Surgery determines muscle substances to be freed into the bloodstream. Myoglo-blin levels resulted to be correlated to those of CPK (r=0.83; P<0.00005). Although serum levels of myogloblin are not determined as a routine procedure, high levels of CPK must induce to dose myogloblin. The amount of muscle substances freed depend on the width of the surgical access (r=0.7; P<0.00005) and not upon extension (r=0.36; P=0.18) or duration of surgery. (r=0.4; P=0.093).


CONCLUSIONS
In patients with a reduced renal function or affected by kidney failure a minimally invasive or thoracoscopic approach is indicated whenever possible in order to reduce the amount of myogloblin in the bloodstream.
Ugolini
D
D
Chest Surgery, Department of Medical and Surgical Specialties, Careggi University Hospital, Florence, Italy. dm@ugolinidm.it
Nucera
M
M
Notaristefano
T
T
Boddi
V
V
Andreani
M
M
Fabbri
L P
LP
Janni
A
A
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003402:Creatine Kinase / Q000097:blood; D003404:Creatinine / Q000097:blood; D003627:Data Interpretation, Statistical; D004231:Diuresis; D005260:Female; D006801:Humans; D007674:Kidney Diseases / Q000150:complications*; D007677:Kidney Function Tests; D007770:L-Lactate Dehydrogenase / Q000097:blood; D008168:Lung / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D009211:Myoglobin / Q000097:blood; D011013:Pneumonectomy; D011182:Postoperative Care; D051437:Renal Insufficiency / Q000150:complications; D013906:Thoracoscopy; D013908:Thoracotomy
D009211:Myoglobin; D003404:Creatinine; D007770:L-Lactate Dehydrogenase; D003402:Creatine Kinase