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Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience.
Inderbir S Gill1, Sidney C Abreu, Mihir M Desai
1Section of Laparascopic and Minimally Invasive Surgery, Urological Institute, Cleveland Clinic Foundation, 9500 Euclid Avenue A-100, Cleveland, OH 44195, USA.
The Journal of Urology
|June 11, 2003
Summary
This study introduces a new laparoscopic technique for renal hypothermia using intracorporeal ice slush during partial nephrectomy. This method successfully preserves kidney function and may enable more complex partial nephrectomies laparoscopically.
Area of Science:
- Urology
- Surgical Innovation
- Oncology
Background:
- Partial nephrectomy is crucial for preserving renal function in patients with renal tumors.
- Laparoscopic partial nephrectomy offers minimally invasive advantages but can be limited by operative complexity and ischemia time.
- Renal hypothermia is a standard technique in open surgery to protect kidney tissue during prolonged ischemia.
Purpose of the Study:
- To describe a novel technique for laparoscopic renal hypothermia using intracorporeal ice slush during partial nephrectomy.
- To report the initial clinical experience and outcomes of this technique in 12 patients.
Main Methods:
- A transperitoneal laparoscopic approach was used for partial nephrectomy in 12 patients with renal tumors.
- A specialized bag was placed around the kidney, and ice slush was introduced intracorporeally to induce hypothermia.
- Renal artery and vein were clamped en bloc, and standard open surgical techniques were replicated laparoscopically.
Main Results:
- The laparoscopic hypothermia technique was successfully completed in all 12 patients without open conversion.
- Median operative time was 4.3 hours, with a median ischemia time of 43.5 minutes.
- Nadir renal parenchymal temperature reached 5°C–19°C, with minimal systemic temperature decrease. All patients had functioning kidneys postoperatively, and 11 had confirmed renal cell carcinoma with negative margins.
Conclusions:
- This is the first clinical report of laparoscopic renal hypothermia with intracorporeal ice slush for partial nephrectomy.
- The technique effectively replicates open surgical hypothermia, potentially expanding the applicability of laparoscopic partial nephrectomy for complex renal tumors.