Step-by-step Development of a Cold Ischemia Device for Open and Robotic-assisted Renal Transplantation.
Cold ischemia device
Kidney transplantation
Robotic surgery
Journal
European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719
Informations de publication
Date de publication:
Dec 2021
Dec 2021
Historique:
received:
09
03
2021
accepted:
20
05
2021
pubmed:
2
6
2021
medline:
19
4
2022
entrez:
1
6
2021
Statut:
ppublish
Résumé
Kidney transplantation (KT) is the best renal replacement treatment. The rewarming time is associated with ischemia/reperfusion damage. In both the open (open KT [OKT]) and the robotic (robotic-assisted KT [RAKT]) approaches, ice slush is used to maintain graft temperature (T°) below 20 °C. This may result in nonhomogeneous graft T° maintenance and, particularly during RAKT where the graft is completely inside the abdominal cavity, rises concerns regarding systemic hypothermia. To design a cold ischemia device (CID) to maintain a constant and homogeneous low graft T° during surgery. In IDEAL phase 0, a CID was developed and tested to determine its cooling effect on the kidney inside a closed system at 37.5 °C, by comparing it with kidney alone versus a gauze-jacket filled with ice slush. The CID was evaluated in pigs undergoing OKT and RAKT, assessing feasibility and adverse reactions. In IDEAL phase 1, the CID was tested in human OKT and RAKT. OKT and RAKT. In all phases, T° was evaluated at scheduled time points. In the preliminary tests of IDEAL phase 0, the CID was able to maintain a low graft T° and superiority to other groups (p = 0.002). In the in vivo animal model, the CID maintained a low and constant graft T° in OKT (n = 3) and RAKT (n = 3), with a mean T° at 50 min of 10.8 °C and 14.9 °C, respectively. IDEAL phase 1 demonstrated feasibility of both approaches (OKT, n = 2 and RAKT, n = 3) using the CID, and graft T° never exceeded 20 °C (mean T°: OKT 15.7 °C vs RAKT 18.3 °C). No complications were recorded. The main limitation consists in the low number of participants. The CID assured a constant low graft T° during rewarming time, in both OKT and RAKT. A cold ischemia device (CID) is the first step toward a feasible, safe, and reproducible method to maintain a low graft temperature during surgery. The employment of a CID may optimize the functional outcomes.
Sections du résumé
BACKGROUND
BACKGROUND
Kidney transplantation (KT) is the best renal replacement treatment. The rewarming time is associated with ischemia/reperfusion damage. In both the open (open KT [OKT]) and the robotic (robotic-assisted KT [RAKT]) approaches, ice slush is used to maintain graft temperature (T°) below 20 °C. This may result in nonhomogeneous graft T° maintenance and, particularly during RAKT where the graft is completely inside the abdominal cavity, rises concerns regarding systemic hypothermia.
OBJECTIVE
OBJECTIVE
To design a cold ischemia device (CID) to maintain a constant and homogeneous low graft T° during surgery.
DESIGN, SETTING, AND PARTICIPANTS
METHODS
In IDEAL phase 0, a CID was developed and tested to determine its cooling effect on the kidney inside a closed system at 37.5 °C, by comparing it with kidney alone versus a gauze-jacket filled with ice slush. The CID was evaluated in pigs undergoing OKT and RAKT, assessing feasibility and adverse reactions. In IDEAL phase 1, the CID was tested in human OKT and RAKT.
SURGICAL PROCEDURE
METHODS
OKT and RAKT.
MEASUREMENTS
METHODS
In all phases, T° was evaluated at scheduled time points.
RESULTS AND LIMITATIONS
CONCLUSIONS
In the preliminary tests of IDEAL phase 0, the CID was able to maintain a low graft T° and superiority to other groups (p = 0.002). In the in vivo animal model, the CID maintained a low and constant graft T° in OKT (n = 3) and RAKT (n = 3), with a mean T° at 50 min of 10.8 °C and 14.9 °C, respectively. IDEAL phase 1 demonstrated feasibility of both approaches (OKT, n = 2 and RAKT, n = 3) using the CID, and graft T° never exceeded 20 °C (mean T°: OKT 15.7 °C vs RAKT 18.3 °C). No complications were recorded. The main limitation consists in the low number of participants.
CONCLUSIONS
CONCLUSIONS
The CID assured a constant low graft T° during rewarming time, in both OKT and RAKT.
PATIENT SUMMARY
RESULTS
A cold ischemia device (CID) is the first step toward a feasible, safe, and reproducible method to maintain a low graft temperature during surgery. The employment of a CID may optimize the functional outcomes.
Identifiants
pubmed: 34059396
pii: S0302-2838(21)01795-4
doi: 10.1016/j.eururo.2021.05.026
pii:
doi:
Substances chimiques
Ice
0
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
738-745Informations de copyright
Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.