title: Renal hypothermia with ice slush in laparoscopic partial nephrectomy: the outcome of renal function.
abstract: OBJECTIVE
  To investigate changes in renal function after retroperitoneal laparoscopic partial nephrectomy (LPN) with renal hypothermia induced by ice-slush cooling.
  
  
  METHODS
  Seventy-one patients undergoing retroperitoneal LPN with renal hypothermia were included. Perioperative outcomes were reviewed retrospectively. The total renal function was evaluated by an estimated glomerular filtration rate (eGFR) preoperatively and 6 months postoperatively in 69 patients. Split renal function (SRF) was also evaluated by 99mTc-mercaptoacetyltriglycine scintigraphy preoperatively and 6 months postoperatively in 61 patients.
  
  
  RESULTS
  The median operative time was 246 minutes (range, 155-424). The median cold ischemic time, including the initial 15 minutes of hypothermia, was 57 minutes (range, 34-112). In the 21 patients whose renal temperature was monitored, median lowest renal temperature was 20.7°C (range, 12.1-27.6). The median baseline eGFR and 6-month postoperative eGFR were 77.2 mL/min/1.73 m(2) (range, 36.1-121.3) and 68.3 mL/min/1.73 m(2) (range, 33.2-103.4), and the median baseline SRF and 6-month postoperative SRF of the affected kidney were 49.3% (range, 40.3-57.6) and 40.7% (range, 13.8-54.5). Using multivariate analysis, the baseline eGFR (p<0.0001) and the ischemic time (p=0.0073) were associated with the 6-month postoperative eGFR, and the 6-month postoperative SRF was only associated with a baseline SRF (p=0.0185).
  
  
  CONCLUSIONS
  Ice-slush cooling could provide renal hypothermia also under LPN. The decrease in renal function was small, whereas our ischemic time was longer than experts' warm ischemic series. These observations suggested the protective effect of our cooling methods against ischemic injury.
authors.affiliation: Department of Urology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. takataka@rf6.so-net.ne.jp
authors.forename: Takashige
authors.initials: T
authors.lastname: Abe
authors.forename: Ataru
authors.initials: A
authors.lastname: Sazawa
authors.forename: Toru
authors.initials: T
authors.lastname: Harabayashi
authors.forename: Nobuo
authors.initials: N
authors.lastname: Shinohara
authors.forename: Satoru
authors.initials: S
authors.lastname: Maruyama
authors.forename: Ken
authors.initials: K
authors.lastname: Morita
authors.forename: Ryuji
authors.initials: R
authors.lastname: Matsumoto
authors.forename: Toshiki
authors.initials: T
authors.lastname: Aoyagi
authors.forename: Katsuya
authors.initials: K
authors.lastname: Nonomura
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001831:Body Temperature; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced; D007053:Ice; D007430:Intraoperative Care; D007511:Ischemia / Q000473:pathology / Q000503:physiopathology; D007668:Kidney / Q000098:blood supply / Q000503:physiopathology*; D007677:Kidney Function Tests; D010535:Laparoscopy; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009392:Nephrectomy / Q000379:methods*; D055815:Young Adult
chemical_list: D007053:Ice