Renal Tolerance to Prolonged Warm Ischemia Time in a Laparoscopic Versus Open Surgery Porcine Model

Laven, Brett A.; Orvieto, Marcelo A.; Chuang, Marc S.; Ritch, Chad R.; Murray, Patrick; Harland, Robert C.; Inman, Sharon R.; Brendler, Charles B.; Shalhav, Arieh L.

doi:10.1097/01.ju.0000138158.16968.8d

Cited by 94 publications

(62 citation statements)

References 17 publications

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“…Based largely on animal models, most studies suggest that warm ischemia longer than 30 minutes results in significant immediate functional loss with either incomplete or absent late recovery (21,22). More recent observations have challenged the maximal safe duration of warm ischemia, suggesting that renal pedicle clamping for 90 minutes is safe in the porcine model (22,23). In our study we have used a 120 minutes ischemia time that is sufficient to cause 25% decline in glomerular filtration rate (24).…”

Section: Discussionmentioning

confidence: 99%

“…The historical safe duration of warm ischemia time, where full recovery of renal function is expected, is thought to be 30 minutes (20). Based largely on animal models, most studies suggest that warm ischemia longer than 30 minutes results in significant immediate functional loss with either incomplete or absent late recovery (21,22). More recent observations have challenged the maximal safe duration of warm ischemia, suggesting that renal pedicle clamping for 90 minutes is safe in the porcine model (22,23).…”

Section: Discussionmentioning

confidence: 99%

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Comparative study between trimetazidine and ice slush hypothermia in protection against renal ischemia/reperfusion injury in a porcine model

et al. 2011

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Purpose: The aim of the study was to compare the effects of renal ice slush hypothermia and the use of trimetazidine in the protection against ischemia/reperfusion (I/R) injury. Materials and Methods: Fifteen farm pigs were submitted to left kidney ischemia and right nephrectomy during the same procedure. Animals were divided into three groups. Group 1 was submitted to warm ischemia; Group 2 was submitted to cold ischemia with ice slush; and Group 3 received trimetazidine 20 mg one day and 4 hours before surgery. Ischemia time was 120 minutes in all three groups. Serum creatinine (SCr) and plasma iohexol clearance (CLioh) were measured before surgery and on postoperative days (PODs) 1,3,7, and 14. Semi-quantitative analyses of histological alterations were performed by a pathologist. A p value of < 0.05 was considered significant. Results: All groups showed elevation of serum creatinine in the first week. Serum creatinine was higher in Group 3 in the first and third postoperative days (Mean Cr: 5.5 and 8.1 respectively). Group 2 showed a lower increase in creatinine and a lower decrease in iohexol clearance than the others. Renal function stabilized in the fourteenth POD in all three groups. Analyses of histological alterations did not reach statistical significance between groups. Conclusion: Trimetazidine did not show protection against renal I/R injury in comparison to warm ischemia or hypothermia in a porcine model submitted to 120 minutes of renal ischemia.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Comparative study between trimetazidine and ice slush hypothermia in protection against renal ischemia/reperfusion injury in a porcine model

et al. 2011

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“…The "safe" window of warm ischemia time is unknown despite several studies assessing its impact. [10][11][12][13] In this series none of the patients had preoperative baseline creatinine Ͼ2.0 mg/dL, so clearly the population was somewhat selected for tolerance of ischemia. Importantly, however, warm ischemia times were relatively short.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Partial Nephrectomy: Fifty Cases

Bhayani

2008

Journal of Endourology

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Purpose: Laparoscopic partial nephrectomy (LPN) is a technically challenging procedure. The goal of this study is to describe the outcomes of 50 consecutive patients undergoing LPN performed by one surgeon.Materials and Methods: Records were reviewed for clinical, pathologic, and follow-up information for patients undergoing LPN. Clinical parameters were assessed in both the first 25 and last 25 cases to see if there was a measurable learning curve.Results: Fifty-two patients underwent attempted LPN; 50 were successful and 2 were converted to open partial nephrectomy. Mean operating room time was 155 minutes, mean estimated blood loss was 172 mL, and mean pathologic size was 2.6 cm. Final pathology revealed malignancy in 60% of cases and oncocytoma in 22% of cases. Margins were clear for all of the primary lesions. Overall complications were 16%, with cardiopulmonary complications being the most common. There were no significant differences in the outcomes of the first 25 and the last 25 patients, with the exception of length of stay (3.1 days v 2.5 days).Conclusions: After laparoendoscopic fellowship training in LPN, acceptable outcomes are achievable, and the learning curve is minimal. Long-term studies are needed on the efficacy of LPN, and further studies need to be performed to optimize the learning process for this technique.

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“…12,13 Lately, however, this notion has been challenged. In view of studies demonstrating negligible effects on renal function after renal pedicle clamping for 90 minutes in porcine models [14][15][16] as well as retrospective clinical observations suggesting that WIT of 40 to 55 minutes may be tolerated, 16,17 some have asserted that the kidney can tolerate longer periods of WIT. Conversely, others have contended that the cutoff defining safe WIT be drawn at 20 minutes, [18][19][20] a view supported by a recent international collaborative review.…”

Section: Discussionmentioning

confidence: 99%

Off-Clamp Robot-Assisted Partial Nephrectomy: Initial Washington University Experience

Tanagho

Bhayani²,

Kim³

et al. 2012

Journal of Endourology

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Tanagho, Youssef S.; Bhayani, Sam B.; Kim, Eric H.; Sandhu, Gurdarshan S.; Vaughn, Nicolas P.; and Figenshau, R. Sherburne, ,"Offclamp robot-assisted partial nephrectomy: Initial Washington University experience." Journal of Endourology.26,10. 1284Endourology.26,10. -1289Endourology.26,10. . (2012 . In all cases, warm ischemia time was 0 minutes. Mean operative time was 143 minutes (SD = 59), and median estimated blood loss was 138 mL (range 50-1500 mL). No intraoperative complications were encountered, and all surgical margins were negative. Our postoperative complication rate was 14.3%. At the most recent follow-up, the mean estimated glomerular filtration rate (eGFR) was 76.2 mL/min/ 1.73 m 2 (SD = 27.6), compared with 78.5 mL/min/1.73 m 2 (SD = 28.9) preoperatively (P = 0.11). Therefore, the mean eGFR decline of 2.3 mL/min/1.73 m 2 (SD = 9.1) was not significant. Conclusions: Off-clamp RAPN is associated with minimal morbidity and minimal decline in renal function on short-term follow-up. Further studies and continued monitoring of renal function are needed to determine if offclamp RAPN provides any advantage in renal function preservation relative to the traditional RAPN with vascular clamping.

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Renal Tolerance to Prolonged Warm Ischemia Time in a Laparoscopic Versus Open Surgery Porcine Model

Cited by 94 publications

References 17 publications

Comparative study between trimetazidine and ice slush hypothermia in protection against renal ischemia/reperfusion injury in a porcine model

Comparative study between trimetazidine and ice slush hypothermia in protection against renal ischemia/reperfusion injury in a porcine model

Laparoscopic Partial Nephrectomy: Fifty Cases

Off-Clamp Robot-Assisted Partial Nephrectomy: Initial Washington University Experience

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