title: Cold intravascular organ perfusion for renal hypothermia during laparoscopic partial nephrectomy.
abstract: OBJECTIVE
  We report initial data on the safety and functional outcomes of renal hypothermia with arterial cold perfusion during partial nephrectomy.
  
  
  METHODS
  From June 2007 to June 2009, 31 consecutive patients underwent laparoscopic partial nephrectomy with hypothermia using renal arterial perfusion with cold, lactated Ringer's solution during renal ischemia. Doppler echography was done intraoperatively to evaluate renal perfusion. Complication data were reported prospectively. Median followup was 57 weeks (IQR 28, 83).
  
  
  RESULTS
  The lowest recorded renal temperature during ischemia was 14C. Median tumor size was 4.0 cm (IQR 2.7, 6.2). Median estimated blood loss was 150 cc (IQR 100, 275). Median ischemia time was 35 minutes (IQR 26, 41). Doppler echography identified intrarenal arterial blood flow postoperatively in all cases. The median change in the estimated glomerular filtration rate from preoperatively to postoperative day 2 was 4 ml per minute (IQR -29, 19). Two months postoperative in 20 patients the median change was 3.5 ml per minute (IQR -6, 16.5). At last followup in 31 patients the overall change in the estimated glomerular filtration rate was -0.5 ml per minute (IQR -6, 6). Six complications developed in a total of 5 patients, of which 5 were grade 2 or less. One grade 3 postoperative hemorrhage from an arteriovenous fistula at the tumor resection site was treated with angiography and selective embolization.
  
  
  CONCLUSIONS
  Cold intravascular perfusion during laparoscopic partial nephrectomy can achieve renal hypothermia below 15C. It is not associated with an immediate risk of renal vascular injury or thrombosis, as measured by Doppler echography in this series. Early changes in postoperative estimates of renal function appear minimal.
authors.affiliation: Department of Surgery, Urology Service, Memorial Sloan-Kettering Cancer Center, New York, New York 10065, USA.
authors.forename: Ciara Siobhan
authors.initials: CS
authors.lastname: Marley
authors.forename: Timothy
authors.initials: T
authors.lastname: Siegrist
authors.forename: Jordan
authors.initials: J
authors.lastname: Kurta
authors.forename: Frank
authors.initials: F
authors.lastname: O'Brien
authors.forename: Melanie
authors.initials: M
authors.lastname: Bernstein
authors.forename: Steven
authors.initials: S
authors.lastname: Solomon
authors.forename: Jonathan Andrew
authors.initials: JA
authors.lastname: Coleman
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007430:Intraoperative Care; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D010477:Perfusion; D011446:Prospective Studies; D012077:Renal Artery