title: Robotic partial nephrectomy with intracorporeal renal hypothermia using ice slush.
abstract: OBJECTIVE
  To outline our technique for intracorporeal cooling with ice slush during robotic partial nephrectomy (RPN), with real-time parenchymal temperature monitoring.
  
  
  METHODS
  Eleven consecutive patients with enhancing solid renal masses suitable for treatment with RPN between September 2013 and January 2014 were included in the analysis. Institutional review board approval and informed consent were obtained. Preoperative patient characteristics, intraoperative surgical parameters including patient body temperature and ipsilateral kidney temperature with real-time monitoring, and short-term functional outcomes were analyzed.
  
  
  RESULTS
  Median age was 55 years (range, 39-75 years) and American Society of Anesthesiologists score was 3 (range, 2-4). Median tumor size was 4 cm (range, 2.3-7.1) and RENAL nephrometry score was 9 (range, 5-11). One patient had a solitary kidney. During cooling, the lowest median renal parenchymal temperature was 17.05°C (range, 11°C-26°C) and cold ischemia time was 27.17 minutes (range, 18-49 minutes). Median time to latest postoperative estimated glomerular filtration rate was 12 days (range, 2-30 days). Median glomerular filtration rate preservation was 81% (range, 47.9%-126%). There was one positive margin. There were no postoperative complications, and no patients experienced a prolonged ileus. The limitations of this study include a small number of patients and short-term follow-up.
  
  
  CONCLUSIONS
  RPN with renal hypothermia using intracorporeal ice slush is technically feasible. Our simplified method of introducing the ice slush was free of complications and highly reproducible. The use of a needle temperature probe allowed us to monitor in real time cooling of the renal parenchyma.
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH. Electronic address: kaoukj@ccf.org.
authors.forename: Jihad H
authors.initials: JH
authors.lastname: Kaouk
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Dinesh
authors.initials: D
authors.lastname: Samarasekera
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Jayram
authors.initials: J
authors.lastname: Krishnan
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Riccardo
authors.initials: R
authors.lastname: Autorino
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Oktay
authors.initials: O
authors.lastname: Acka
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Luis Felipe
authors.initials: LF
authors.lastname: Brando
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Humberto
authors.initials: H
authors.lastname: Laydner
authors.affiliation: Center for Laparoscopic and Robotic Surgery, Glickman Urologic and Kidney Institute, Cleveland Clinic, Cleveland, OH.
authors.forename: Homayoun
authors.initials: H
authors.lastname: Zargar
mesh_terms: D000328:Adult; D000368:Aged; D001831:Body Temperature; D002292:Carcinoma, Renal Cell / Q000601:surgery; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D007053:Ice; D007668:Kidney / Q000601:surgery; D007680:Kidney Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009392:Nephrectomy / Q000379:methods*; D011184:Postoperative Period; D012371:Robotics; D013514:Surgical Procedures, Operative; D013696:Temperature; D013997:Time Factors; D052096:Warm Ischemia
chemical_list: D007053:Ice