Balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy.
OBJECTIVE
We describe our initial experience with renal arterial catheterization for temporary balloon occlusion of renal artery and hypothermic perfusion during laparoscopic partial nephectomy and compare the preoperative and postoperative nephron function.


METHODS
Fifteen patients received laparoscopic partial nephrectomy from September 2005 to December 2006. During the operations, the balloons of the arterial catheters were filled with distilled water to achieve pedicle control. Chilled Ringers lactate was continuously infused into the catheters for renal hypothermia. Postoperative Tc-99m diethylenetriamine pentaacetic acid (DTPA) renal scintigraphies were carried out to estimate differential renal function. The volumes of the renal tumors, tumor-bearing and contralateral kidneys from CT scans were measured using commercial software. Estimated creatinine clearance was calculated with Cockroft Gault formula.


RESULTS
All procedures were successfully completed. Mean tumor size was 18.4 mL (range 2.14 to 59.0). Estimated mean intraoperative blood loss was 287 mL (range minimal to 1200). Mean estimated creatinine clearance per unit volume of functional renal parenchyma did not change statistically after the operation. Multiple regression analysis revealed that ischemic time was a significant variable which correlated with the value of lost total estimated creatinine clearance of the tumor bearing kidney.


CONCLUSIONS
The initial experience shows that renal arterial catheterization for temporary balloon occlusion and hypothermic perfusion of the renal artery in laparoscopic partial nephectomy is safe, feasible and effective. The postoperative kidney function measured by mean estimated creatinine clearance per unit of functional renal volume was similar to the preoperative measurement.
Shen
Heng-Li
HL
Department of Urology, National Taiwan University Hospital, Taipei, Taiwan.
Chueh
Shih-Chieh
SC
Lai
Ming-Kuen
MK
Wu
Chen-Han Welfred
CH
Huang
Chun-Chieh
CC
Tsang
Yuk-Ming
YM
Chuang
Chiu-Chen
CC
Lai
Ming-Chih
MC
Yu
Hong-Jeng
HJ
D000328:Adult; D000368:Aged; D021721:Balloon Occlusion; D002292:Carcinoma, Renal Cell / Q000601:surgery*; D002404:Catheterization; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007677:Kidney Function Tests; D007680:Kidney Neoplasms / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D009399:Nephrons / Q000502:physiology; D010477:Perfusion; D011182:Postoperative Care; D011300:Preoperative Care; D012077:Renal Artery