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Cooling mechanisms in laparoscopic partial nephrectomy: are really necessary?
Stephan Hruby1, Lukas Lusuardi, Stephan Jeschke
1Department of Urology and Andrology, Paracelsus Medical University, Salzburg, Austria. stephan.hruby@gmx.at
Objective:
The purpose of this review is to provide an overview of the possibilities and drawbacks of the various possibilities of renal parenchymal cooling during laparoscopic partial nephrectomy and also give an outlook into future developments.
Methods:
In January 2012 a PubMed Search using the search terms "partial nephrectomy, cooling," followed by a systematic and critical review was performed.
Conclusion:
Renal cooling during laparoscopic partial nephrectomy is a feasible, safe and effective procedure to expand ischemia time up to over 60 minutes, without risking significant and long lasting deterioration of renal function. It can be of value in patients with an imperative indication for partial nephrectomy, like solitary kidneys, synchronous bilateral tumors or renal failure in the opposite kidney as well as for patients at risk for deterioration of renal function and in any situation, where you think to yourself that 20 minutes will be maybe not enough to finish the job technically. Renal arterial perfusion provides the clinically best-studied option in this situation followed by ice-cold saline irrigation. Other surface coolants look promising, but still lack clinical data.
