Laparoscopic renal parenchymal hypothermia with novel ice-slush deployment mechanism

Novel technique for in situ cold perfusion in laparoscopic partial nephrectomy

“…Weld et al [14] presented intermittent surface cooling with near-freezing saline. Surface cooling in a porcine model was also achieved by a newly developed ice-slush deployment mechanism or microparticulate ice slurry [8]. Landman et al [12] and Crain et al [25] studied the effect of transureteral saline perfusion compared to ice slush cooling on renal hypothermia in a porcine model, with conflicting results.…”

“…As in open surgery, whenever ischemia time is expected to exceed 30 min, renal cooling is considered mandatory [7]. Several methods to achieve renal hypothermia by laparoscopic techniques to increase the tolerance of renal parenchyma to ischemic damage have been published [8][9][10][11][12][13][14]. However, these techniques have not been widely embraced [4].…”

Laparoscopic renal cooling device

“…In our animal trials, the mean temperature accomplished after 30 min was 4.6°C lower. The other methods of topical cooling involved the application of ice slush [2,9,13,18] or ice-cold saline [20] laparoscopically directly into contact with the renal tissue. The temperatures reached by these methods ranged from 5 to 20°C.…”

“…A method for use in a laparoscopic procedure is not so straightforward, though several attempts have been made. These include deploying ice slush around the kidney by different means [2,9,18], passing cold saline across the kidney surface [20], use of a cooling sheath [10] and retrograde ureteral or arterial perfusion of the kidney with cold saline [11,12]. Though all these techniques achieved some level of localised hypothermia, each method had its disadvantages.…”

“…Though all these techniques achieved some level of localised hypothermia, each method had its disadvantages. These included difficulty in deployment around the kidney [10], release of saline or ice slush in to the abdominal cavity increasing the potential of hypothermia in the patient [2,9,18] or limited minimum temperatures [11,12].…”