Continuous In Situ Cold Perfusion With Histidine Tryptophan Ketoglutarate Solution in Nephron Sparing Surgery for Renal Tumors

Abstract

Continuous in situ perfusion with Bretschneider's solution is a new and interesting method for patients undergoing partial nephrectomy. Particularly for locally extended tumors, this procedure is highly efficient for intrarenal surgery.

Adenocarcinoma of the kidney: Nephron-sparing surgical approach vs. radical nephrectomy

“…Certainly, there is no unanimous agreement in the literature regarding this principle, but one has to be very cautious to preserve renal function, especially when it is proven that removal of the kidney does not alter patient survival, as was clearly shown in this and other presentations [28][29][30].…”

Novel technique for in situ cold perfusion in laparoscopic partial nephrectomy

“…[16], Gschwend et al [15], and Steffens et al [17] occluded the renal artery and vein close to the large vessels. Following a small arteriotomy, a cannula or perfusion catheter was introduced and a hydrostatic pressure of 55-75 cm H 2 O was maintained throughout the entire ischemia time [15,16] or the cannula was removed after 500 cc of cold perfusion and additional surface cooling was administered [17]. In contrast to the study by Marberger et al [24], these authors performed a venotomy which solved the problem of a possible fluid overload by the perfusate.…”

“…For this reason, we attempted to establish a solely laparoscopic procedure allowing a direct cannulation of the renal artery comparable to the open techniques of Gschwend et al [15] and Steffens et al [17]. The main problem was the fixation of the perfusion catheter.…”

“…After approval of the local Ethics and Research committee, the standardization of laparoscopic partial nephrectomy with continuous in situ perfusion was established using six female pigs. We tried to duplicate the principles of the open counterpart as described by Gschwend et al [15] and Steffens et al [17] with clamping of the renal vessels, perfusion via an arteriotomy, and drainage of the perfusate via a venotomy. Certain prerequisites exist to successfully transfer this open technique into laparoscopy: first, it is necessary to reliably occlude the renal artery and vein close to the aorta and vena cave.…”

“…In situ perfusion of central organs enables organ-conserving operations to be performed under total ischemia with almost complete protection of function and ultrastructure [15] and has been successfully applied in open nephron-sparing surgery [15][16][17]. Therefore, we tried to develop a solely laparoscopic technique for in situ cold perfusion of kidneys during laparoscopic partial nephrectomy and to determine the technical feasibility in a porcine model.…”