Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Abstract

Robot‐assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra‐abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra‐abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p‐values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia–reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot‐assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra‐abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia–reperfusion injuries.

Impact of an intra-abdominal cooling device during open kidney transplantation in pigs

“…4A and B). The Goujon score [22], combines all the previous histopathological observations into a score, and suggested that cooling protected from IRI (Fig. 4).…”

“…Water and food were provided ad libitum. Animals were allocated Surgery was performed as described [22]. Briefly, following a midline incision, the peritoneal cavity was opened, and the bowels were reclined.…”

“…The cooling system previously described elsewhere [22], and was made of a double silicone sheath, continuously perfused with 4°C ethanol and methylene blue (Fig. 1C).…”

“…Sections of 3μm thickness were prepared from formalin fixed kidney biopsies, and stained with silver Jones and Periodic Acid-Schiff (PAS). Histopathological analysis score was performed based on those described by Goujon et al [22,23] using Osirix software. Four different representative fields were assessed and blinded to group assignment.…”

“…Recently, we developed a cooling device, made of double silicone device in which ethanol and methylene blue continuously circulate. In the setting of robot-assisted kidney transplantation, this device, allowed strict temperature control, which prevented kidney ischemia-reperfusion injuries, [22]. During standard open kidney transplant, vascular anastomoses are easier, and faster, thus second warm ischemic is relatively short.…”