Laparoscopic Renal Parenchymal Hypothermia With Novel Ice-Slush Deployment Mechanism

Ames, Caroline D.; Venkatesh, Ramakrishna; Weld, Kyle J.; Morrissey, Kevin; Foyil, Kelley V.; Shen, T.; Dryer, Stephen; Hruby, Greg; Sutera, Salvatore P.; Landman, Joshua M

doi:10.1016/s0022-5347(05)00560-4

Cited by 4 publications

(6 citation statements)

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“…Previous authors have described various methods of renal cooling during laparoscopic partial nephrectomy, including intraoperative peri-renal ice slush (12) or cool saline irrigation (13)(14)(15)(16)(17)(18)(19), arterial infusion of cooled saline (22,23). When employed, authors found a decreased in ischemic nephron damage following renal vessel clamping in animal and/or human subjects.…”

Section: Discussionmentioning

confidence: 99%

“…Several authors have described alternative methods of inducing renal hypothermia during laparoscopic partial nephrectomy with resultant decreases in warm ischemia related kidney injury (12)(13)(14)(15)(16)(17). Retrograde ureteric renal perfusion cooling was one of the first alternative cooling methods described in 2002 by Landman et al (18).…”

Section: Introductionmentioning

confidence: 99%

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Retrograde Renal Cooling to Minimize Ischemia

et al. 2013

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Objective: During partial nephrectomy, renal hypothermia has been shown to decrease ischemia induced renal damage which occurs from renal hilar clamping. In this study we investigate the infusion rate required to safely cool the entire renal unit in a porcine model using retrograde irrigation of iced saline via dual-lumen ureteral catheter. Materials and Methods: Renal cortical, renal medullary, bowel and rectal temperatures during retrograde cooling in a laparoscopic porcine model were monitored in six renal units. Iced normal saline was infused at 300 cc/hour, 600 cc/hour, 1000 cc/hour and gravity (800 cc/hour) for 600 seconds with and without hilar clamping. Results: Retrograde cooling with hilar clamping provided rapid medullary renal cooling and significant hypothermia of the medulla and cortex at infusion rates ≥ 600 cc/hour. With hilar clamping, cortical temperatures decreased at -0.9 0 C/min. reaching a threshold temperature of 26.9 0 C, and medullary temperatures decreased at -0.90 C/min. reaching a temperature of 26.1 0 C over 600 seconds on average for combined data at infusion rates ≥ 600 cc/hour. The lowest renal temperatures were achieved with gravity infusion. Without renal hilum clamping, retrograde cooling was minimal at all infusion rates. Conclusions: Significant renal cooling by gravity infusion of iced cold saline via a duel lumen catheter with a clamped renal hilum was achieved in a porcine model. Continuous retrograde irrigation with iced saline via a two way ureteral catheter may be an effective method to induce renal hypothermia in patients undergoing robotic assisted and/or laparoscopic partial nephrectomy.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Retrograde Renal Cooling to Minimize Ischemia

et al. 2013

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“…Currently, the inability to efficiently establish laparoscopic renal hypothermia has limited the laparoscopic management of more complicated renal tumours and renovascular diseases [1,2,12–14]. Thus efficient renal cooling techniques remain a focus of laparoscopic renal surgery research [12–15].…”

Section: Discussionmentioning

confidence: 99%

“…The authors also commented that space limitations prevent the use of this technique in retroperitoneoscopic procedures. Recently, Ames et al [15] investigated an ice slurry that can be topically applied to the kidney. There was efficient cooling but the slurry required a custom‐built 10‐mm delivery device to prevent plugging from ice‐crystal agglomeration characteristic of dendritic ice‐slush mixtures.…”

Section: Discussionmentioning

confidence: 99%

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A pilot study of ice‐slurry application for inducing laparoscopic renal hypothermia

et al. 2006

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laparoscopically exposed; thermocouple probes were placed throughout the kidney and the hilum was clamped. MPS was delivered through a modified 5-mm laparoscopic suction/irrigation cannula. Cortical and core body temperatures were measured. RESULTSIn the ex vivo study, the mean ( SD ) initial temperature was 37.1 (0.4) ° C; the mean time to reach 15 ° C was 10.3 (2.6) min and the mean nadir temperature was 13.0 (1.5) ° C. In vivo , the MPS was delivered with no technical difficulty; the mean renal unit starting temperature and core body temperature were 37.2 ° C and 37.0 ° C, respectively. The mean (range) time to reach 15 ° C was 16.5 (5.5-28.6) min. The mean nadir core body temperature was 34.0 ° C. CONCLUSIONThis initial study showed efficient and rapid induction of renal hypothermia using MPS delivered through 5-mm laparoscopic ports, with no technical difficulty. These exploratory pilot findings support further, larger scale, histopathological and renal functional investigations of topical ice slurries as a means of providing renal hypothermia in laparoscopic procedures.

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