Temporary segmental renal artery occlusion using reverse phase polymer for bloodless robotic partial nephrectomy.
OBJECTIVE
Renal vascular clamping with ensuing warm ischemia is typically needed during robotic or laparoscopic partial nephrectomy. We developed a technique for angiographic delivery of the novel intra-arterial reverse thermoplastic polymer LeGoo-XL that allows temporary selective vascular occlusion with normal perfusion of the remaining kidney.


METHODS
Eight pigs underwent a total of 16 selective angiographic occlusions of the lower pole segmental artery using gel polymer. The technical feasibility of 2 hemostatic techniques, perfusion hemostasis and local plug formation, was assessed in 4 pigs each. Selective ischemia time was recorded and the vascular occlusion site was noted radiographically and laparoscopically. The feasibility of reversing the polymer from solid back to liquid state to allow reperfusion was determined. Pathological analysis of the kidney was completed in these acute model pigs. In the last 2 cases lower pole robotic partial nephrectomy was done using the da Vinci surgical system.


RESULTS
Selective lower pole ischemia was achieved in all 8 cases. Perfusion hemostasis yielded an inconsistent duration of occlusion (zero to greater than 60 minutes). Vascular occlusion time using local plug formation was more reliable (17 to 30 minutes) with consistent ability to reverse the plug to liquid state by cold saline flush. Two lower pole robotic partial nephrectomies were completed with minimal blood loss.


CONCLUSIONS
We developed a reliable technique of angiographic delivery of gel polymer for temporary vascular occlusion of selective renal artery branches using local plug formation. Ongoing studies are under way to assess technique consistency and the long-term effects of the polymer.
Moinzadeh
Alireza
A
Lahey Clinic, Burlington and Pluromed, Inc., Woburn, Massachusetts 01805, USA. moinza00@lahey.org
Flacke
Sebastian
S
Libertino
John A
JA
Merhige
John
J
Vogel
Jean-Marie
JM
Lyall
Katy
K
Bakal
Curtis W
CW
Madras
Peter N
PN
D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004621:Embolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D006488:Hemostasis, Surgical / Q000379:methods*; D010535:Laparoscopy; D009392:Nephrectomy / Q000379:methods*; D020442:Poloxamer; D012077:Renal Artery; D012371:Robotics; D013552:Swine; D013997:Time Factors
C539704:LeGoo; D020442:Poloxamer
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