title: Renal damage caused by warm ischaemia during laparoscopic and robot-assisted partial nephrectomy: an assessment using Tc 99m-DTPA glomerular filtration rate.
abstract: BACKGROUND
  Few studies assessing the functional change of each kidney following warm ischaemia after partial nephrectomy are available.
  
  
  OBJECTIVE
  Our aim was to identify the effects of the warm ischaemic time (WIT) on renal function after partial nephrectomy under the pneumoperitoneum.
  
  
  METHODS
  Forty-four consecutive patients who underwent laparoscopic partial nephrectomy (LPN) or robot-assisted partial nephrectomy (RAPN) from June 2008 to May 2009 for a single cT1 renal tumour were included in this prospective protocol.
  
  
  METHODS
  Technetium Tc 99m-diethylenetriaminepentaacetic acid (Tc 99m-DTPA) renal scintigraphy was used to determine the glomerular filtration rate (GFR) of both kidneys and each kidney individually. Tc 99m-DTPA GFR was performed preoperatively and 3 mo postoperatively. In addition, we analysed Tc 99m-DTPA scintigraphy GFR regionally in the healthy areas of the affected kidney.
  
  
  CONCLUSIONS
  Patients with WIT > 28 min had a significantly greater decrease in the GFR of the affected kidney (p = 0.031). The GFR of the affected kidney showed a significant decrease perioperatively (46.4 ± 14.3 to 37.9 ± 11.9 ml/min per 1.73 m²; p = 0.003). The functional change of the nonaffected kidney showed an increasing trend (47.5 ± 13.8 to 51.4 ± 14.3 ml/min per 1.73 m²), although it was not statistically significant (p=0.103). Regional Tc 99m-DTPA GFR of both affected kidney and nonaffected kidney showed no significant differences perioperatively (6.3 ± 1.8 to 6.1 ± 1.9 ml/min per 1.73 m²; p = 0.641; 6.6 ± 1.9 to 7.1 ± 2.0 ml/min per 1.73 m² ; p = 0.200). On multivariate analysis, preoperative GFR, resected volume of marginal healthy tissue, and WIT were independent predictors for functional reduction of the affected kidney (p < 0.05). The study was limited by small numbers and short follow-up periods.
  
  
  CONCLUSIONS
  Stationary overall renal function after LPN or RAPN is masked possibly by functional compensation of the contralateral healthy kidney. The damage of the affected kidney estimated by scintigraphy occurs when WIT exceeds 28 min during partial nephrectomy under the pneumoperitoneum.
authors.affiliation: Department of Urology, Samsung Medical Centre, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
authors.forename: Jae Duck
authors.initials: JD
authors.lastname: Choi
authors.forename: Jong Wook
authors.initials: JW
authors.lastname: Park
authors.forename: Joon Young
authors.initials: JY
authors.lastname: Choi
authors.forename: Hong Seok
authors.initials: HS
authors.lastname: Kim
authors.forename: Byong Chang
authors.initials: BC
authors.lastname: Jeong
authors.forename: Seong Soo
authors.initials: SS
authors.lastname: Jeon
authors.forename: Hyun Moo
authors.initials: HM
authors.lastname: Lee
authors.forename: Han Yong
authors.initials: HY
authors.lastname: Choi
authors.forename: Seong Il
authors.initials: SI
authors.lastname: Seo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D007680:Kidney Neoplasms / Q000473:pathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D015427:Reperfusion Injury / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D056910:Republic of Korea; D018570:Risk Assessment; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted; D016284:Technetium Tc 99m Pentetate; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects*; D055815:Young Adult
chemical_list: D019275:Radiopharmaceuticals; D016284:Technetium Tc 99m Pentetate