Robotic cold ischemia achieves comparable functional outcomes to open cold ischemia during partial nephrectomy for complex kidney tumors

Abstract

Objectives:To compare the perioperative and functional outcomes after open and robotic partial nephrectomy performed with cold ischemia.Methods:A retrospective chart review was completed of consecutive patients who underwent partial nephrectomy with renal hypothermia between January 2011 and September 2016. The study cohort included both open (Open Cold Ischemia, OCI; n=170) and robotic (Robotic Cold Ischemia, RCI; n=31) patients with complex renal masses (R.E.N.A.L. score >7) who did not meet exclusion criteria. A modified intracorporeal technique 1 was utilized for the introduction of ice slush at the time of hilar clamping in the RCI group. Statistical testing was performed to compare key perioperative and functional outcomes after ensuring equilibration of both groups by clinicodemographic criteria.Results:Both groups were statistically equivalent with respect to baseline characteristics. Median GFR preservation postoperatively was 86.7% for the open group and 86.6% in the robotic group (p=0.49). Cold ischemia time (CIT) in the open group was 35 minutes compared to 28 minutes (p = 0.03) in the robotic group. LOS was significantly shorter by 2 days (p < 0.01) in the robotic group. Positive margins was noted to be 17 (10%) in the open group and 2 (6.5%) patients in the robotic group (p=0.48).Conclusions:We demonstrate an effective and simplified method of intracorporeal ice cooling during robotic partial nephrectomy. Our data suggests that results with this approach compare favorably to open cold ischemia technique. Intracorporeal ice cooling can be considered when performing complex partial nephrectomies with ischemia times expected to exceed 25 minutes.

A retrospective study of open and endoscopic nephron sparing surgery in the treatment of complex renal tumors

“…Furthermore, radical nephrectomy can save the lives of patients to the maximum degree. 19,20 This study showed that although laparoscopic partial nephrectomy is widely used, open surgery plays a crucial role.…”

The efficacy evaluation of partial nephrectomy with selective renal artery branch occlusion by laparoscopy

“…[17] In conclusion, partial nephrectomy with renal artery branch occlusion is safe, effective, and has better efficacy in the treatment of early renal cancer. Undeniably, on the basis of traditional renal artery occlusion, various cooling methods, such as retrograde intubation hypothermia, ice chip hypothermia, and perfusion hypothermia via renal artery [18] are also effective methods to protect renal function. Although partial nephrectomy without interruption or suture is more promising and advantageous in recent years, the risk and complications are also increased.…”

Renal and major clinical outcomes and their determinants after nephrectomy in patients with pre-existing chronic kidney disease: A retrospective cohort study

“…Retrospective studies have reported an incidence of post-operative AKI following PN with renal clamping that ranged from 20 to 40%, associated with a worse renal function 1 year after surgery [ 15 – 17 ]. Robot-assisted PN seemed interesting since it was associated in some studies with a shorter ischemia time than open or laparoscopic PN [ 18 , 19 ] but studies failed to demonstrate its benefit on renal function preservation [ 11 , 12 , 18 , 20 ]. In a recent prospective randomized study, super selective clamping of tumor-targeted arteries also failed to provide better renal function preservation compared to conventional robot-assisted PN [ 21 ], in addition, achieving zero ischemia during NSS through “off clamp” procedures has also been proposed to avoid renal ischemia reperfusion injuries, but it remains technically demanding [ 22 ].…”