title: Does prolonged warm ischemia after partial nephrectomy under pneumoperitoneum cause irreversible damage to the affected kidney?
abstract: OBJECTIVE
  We determined the effects of warm ischemia time on the recovery of renal function after partial nephrectomy under pneumoperitoneum.
  
  
  METHODS
  In this prospective study 37 consecutive patients who underwent laparoscopic partial nephrectomy or robot-assisted partial nephrectomy between June 2008 and May 2009 to remove a single cT1 renal tumor were evaluated using (99m)Tc-diethylenetriamine pentaacetic acid renal scintigraphy preoperatively, and at 3 and 12 months postoperatively.
  
  
  RESULTS
  The most significant reduction in the glomerular filtration rate of the affected kidney at 3 and 12 months after surgery (p = 0.018, p = 0.036, respectively) was seen for a warm ischemia time cutoff of 28 minutes. The glomerular filtration rate of the affected kidney was consistently and significantly reduced at 3 and 12 months postoperatively (-22.4% to -30.6%, p <0.001) in patients with a warm ischemia time greater than 28 minutes. In contrast, no significant glomerular filtration rate change was seen in patients with a warm ischemia time of 28 minutes or less. In terms of the contributional change of the affected kidney to total renal function, there is a trend toward a recovery after an initial decrease in both groups with a warm ischemia time greater than 28 minutes vs 28 minutes or less. On multivariate analysis warm ischemia time was a strong independent predictor of glomerular filtration rate reduction even 12 months after surgery (β = -1.3; 95% CI -1.8, -0.7; p <0.001).
  
  
  CONCLUSIONS
  If the warm ischemia time is greater than 28 minutes during laparoscopic partial nephrectomy or robot-assisted partial nephrectomy, the functional damage to the affected kidney progresses even up to 1 year after surgery.
authors.affiliation: Department of Urology, Dongguk University Hospital, School of Medicine, Gyungju, 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: Seo Yeon
authors.initials: SY
authors.lastname: Lee
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: D016009:Chi-Square Distribution; D018450:Disease Progression; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007668:Kidney / Q000000981:diagnostic imaging / Q000503:physiopathology*; D007680:Kidney Neoplasms / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011028:Pneumoperitoneum, Artificial; D011446:Prospective Studies; D011877:Radionuclide Imaging; D019275:Radiopharmaceuticals; D020127:Recovery of Function; D012371:Robotics; D018709:Statistics, Nonparametric; D016284:Technetium Tc 99m Pentetate / Q000031:analogs & derivatives; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia / Q000009:adverse effects*
chemical_list: D019275:Radiopharmaceuticals; C481867:technetium Tc 99m diethylene triamine pentaacetic acid, dimethyl ester; D016284:Technetium Tc 99m Pentetate