Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique.
Intra-arterial cooling
Ischemia time
Partial nephrectomy
Renal cell carcinoma
Robot-assisted surgery
Three-dimensional models
Journal
European urology open science
ISSN: 2666-1683
Titre abrégé: Eur Urol Open Sci
Pays: Netherlands
ID NLM: 101771568
Informations de publication
Date de publication:
Dec 2023
Dec 2023
Historique:
accepted:
16
10
2023
medline:
29
11
2023
pubmed:
29
11
2023
entrez:
29
11
2023
Statut:
epublish
Résumé
In partial nephrectomy for highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage. To describe our case series, surgical technique, and early outcomes for robot-assisted partial nephrectomy (RAPN) using intra-arterial cold perfusion through arteriotomy. A retrospective analysis was conducted of ten patients with renal tumors (PADUA score 9-13) undergoing RAPN between March 2020 and March 2023 with intra-arterial cooling because of expected arterial clamping times longer than 25 min. Multiport transperitoneal RAPN with full renal mobilization and arterial, venous, and ureteral clamping was performed. After arteriotomy and venotomy, 4°C heparinized saline is administered intravascular through a Fogarty catheter to maintain renal hypothermia while performing RAPN. Demographic data, renal function, console and ischemia times, surgical margin status, hospital stay, estimated blood loss, and complications were analyzed. The median warm and cold ischemia times were 4 min (interquartile range [IQR] 3-7 min) and 60 min (IQR 33-75 min), respectively. The median rewarming ischemia time was 10.5 min (IQR 6.5-23.75 min). The median pre- and postoperative estimated glomerular filtration rate values at least 1 mo after surgery were 90 ml/min (IQR 78.35-90 ml/min) and 86.9 ml/min (IQR 62.08-90 ml/min), respectively. Limitations include small cohort size and short median follow-up (13 [IQR 9.1-32.4] mo). We demonstrate the feasibility and first case series for RAPN using intra-arterial renal hypothermia through arteriotomy. This approach broadens the scope for minimal invasive nephron-sparing surgery in highly complex renal masses. We demonstrate a minimally invasive surgical technique that reduces kidney infarction during complex kidney tumor removal where surrounding healthy kidney tissue is spared. The technique entails arterial cold fluid irrigation, which temporarily decreases renal metabolism and allows more kidneys to be salvaged.
Sections du résumé
Background
UNASSIGNED
In partial nephrectomy for highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage.
Objective
UNASSIGNED
To describe our case series, surgical technique, and early outcomes for robot-assisted partial nephrectomy (RAPN) using intra-arterial cold perfusion through arteriotomy.
Design setting and participants
UNASSIGNED
A retrospective analysis was conducted of ten patients with renal tumors (PADUA score 9-13) undergoing RAPN between March 2020 and March 2023 with intra-arterial cooling because of expected arterial clamping times longer than 25 min.
Surgical procedure
UNASSIGNED
Multiport transperitoneal RAPN with full renal mobilization and arterial, venous, and ureteral clamping was performed. After arteriotomy and venotomy, 4°C heparinized saline is administered intravascular through a Fogarty catheter to maintain renal hypothermia while performing RAPN.
Measurements
UNASSIGNED
Demographic data, renal function, console and ischemia times, surgical margin status, hospital stay, estimated blood loss, and complications were analyzed.
Results and limitations
UNASSIGNED
The median warm and cold ischemia times were 4 min (interquartile range [IQR] 3-7 min) and 60 min (IQR 33-75 min), respectively. The median rewarming ischemia time was 10.5 min (IQR 6.5-23.75 min). The median pre- and postoperative estimated glomerular filtration rate values at least 1 mo after surgery were 90 ml/min (IQR 78.35-90 ml/min) and 86.9 ml/min (IQR 62.08-90 ml/min), respectively. Limitations include small cohort size and short median follow-up (13 [IQR 9.1-32.4] mo).
Conclusions
UNASSIGNED
We demonstrate the feasibility and first case series for RAPN using intra-arterial renal hypothermia through arteriotomy. This approach broadens the scope for minimal invasive nephron-sparing surgery in highly complex renal masses.
Patient summary
UNASSIGNED
We demonstrate a minimally invasive surgical technique that reduces kidney infarction during complex kidney tumor removal where surrounding healthy kidney tissue is spared. The technique entails arterial cold fluid irrigation, which temporarily decreases renal metabolism and allows more kidneys to be salvaged.
Identifiants
pubmed: 38028235
doi: 10.1016/j.euros.2023.10.004
pii: S2666-1683(23)01799-8
pmc: PMC10660005
doi:
Types de publication
Journal Article
Langues
eng
Pagination
19-27Informations de copyright
© 2023 The Authors.
Références
BJU Int. 2002 Nov;90(7):627-34
pubmed: 12410737
Eur Urol Focus. 2019 Nov;5(6):939-942
pubmed: 31000493
J Urol. 2013 Jan;189(1):36-42
pubmed: 23164381
World J Urol. 2011 Jun;29(3):337-42
pubmed: 20922393
Eur Urol. 2014 May;65(5):991-1000
pubmed: 24388099
Eur Urol. 2023 May;83(5):413-421
pubmed: 36737298
Eur Urol. 2023 Jul;84(1):86-91
pubmed: 36941148
Cent European J Urol. 2020;73(2):234-235
pubmed: 32782846
BJU Int. 2016 Nov;118(5):692-705
pubmed: 27409986
Ann Surg. 2004 Aug;240(2):205-13
pubmed: 15273542
Ren Fail. 2002 Mar;24(2):147-63
pubmed: 12071589
J Reprod Med. 1974 Jun;12(6):234-8
pubmed: 4275895
World J Urol. 2012 Apr;30(2):257-63
pubmed: 21769680
Eur Urol. 2010 Sep;58(3):340-5
pubmed: 20825756
Sci Rep. 2022 Nov 8;12(1):18981
pubmed: 36347900
J Urol. 2004 Jan;171(1):68-71
pubmed: 14665846
World J Urol. 2023 May;41(5):1337-1344
pubmed: 37085644
Arch Esp Urol. 2013 Jan-Feb;66(1):139-45
pubmed: 23406809
Acad Radiol. 2019 Aug;26(8):e196-e201
pubmed: 31284936
J Urol. 2011 May;185(5):1598-603
pubmed: 21419452
Eur Urol. 2009 Oct;56(4):625-34
pubmed: 19656615
BJU Int. 2022 Feb;129(2):217-224
pubmed: 34086393
Eur Urol. 2009 Mar;55(3):592-9
pubmed: 19144457
J Urol. 1995 Oct;154(4):1307-11
pubmed: 7658525
Eur Urol. 2022 Oct;82(4):399-410
pubmed: 35346519
J Emerg Med. 1990 Sep-Oct;8(5):635-7
pubmed: 2254614
Eur Urol Focus. 2018 Mar;4(2):198-205
pubmed: 30093358
Surg Endosc. 2008 Oct;22(10):2184-9
pubmed: 18594923
J Urol. 2010 Nov;184(5):1861-6
pubmed: 20846690
JSLS. 2004 Jul-Sep;8(3):217-22
pubmed: 15347107
Eur Urol. 2022 Feb;81(2):168-175
pubmed: 34393012
J Urol. 2003 Jul;170(1):52-6
pubmed: 12796643
Urology. 1975 Apr;5(4):456-60
pubmed: 1093302
BJU Int. 2005 Sep;96(4):608-11
pubmed: 16104919
J Urol. 1980 Aug;124(2):179-83
pubmed: 7401227
J Robot Surg. 2022 Oct;16(5):1183-1192
pubmed: 35094219
Front Surg. 2020 Dec 11;7:65
pubmed: 33425979