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Temporary segmental renal artery occlusion using reverse phase polymer for bloodless robotic partial nephrectomy.

Alireza Moinzadeh¹, Sebastian Flacke, John A Libertino

¹Lahey Clinic, Burlington and Pluromed, Inc., Woburn, Massachusetts 01805, USA. moinza00@lahey.org

The Journal of Urology

|August 18, 2009

Summary

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A new gel polymer technique enables temporary selective renal artery occlusion during partial nephrectomy, allowing other kidney parts to maintain normal perfusion. This method offers reliable, reversible vascular control for minimally invasive kidney surgery.

Area of Science:

Urology
Vascular Surgery
Interventional Radiology

Background:

Robotic and laparoscopic partial nephrectomy often require renal vascular clamping, leading to warm ischemia.
Maintaining perfusion to non-target kidney areas during partial nephrectomy is a surgical challenge.

Purpose of the Study:

To develop and assess a novel technique for temporary, selective renal artery occlusion using an intra-arterial thermoplastic polymer (LeGoo-XL).
To enable selective vascular occlusion while preserving perfusion to the remaining kidney during partial nephrectomy.

Main Methods:

Eight pigs underwent 16 selective angiographic occlusions of the lower pole segmental artery using a gel polymer.
Two hemostatic techniques (perfusion hemostasis and local plug formation) were evaluated.

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Feasibility of reversing the polymer plug to a liquid state for reperfusion was assessed.

Acute pathological analysis and robotic partial nephrectomies were performed.

Main Results:

Selective lower pole ischemia was successfully achieved in all cases.
Local plug formation provided reliable occlusion times (17-30 minutes) and was consistently reversible.
Perfusion hemostasis resulted in inconsistent occlusion durations.
Two robotic partial nephrectomies were completed with minimal blood loss.

Conclusions:

A reliable technique for temporary selective renal artery branch occlusion using angiographically delivered gel polymer (local plug formation) was developed.
This technique allows for controlled ischemia and reperfusion during partial nephrectomy.
Further studies are ongoing to evaluate technique consistency and long-term polymer effects.