Warm Ischaemia: The Ultimate Enemy for Partial Nephrectomy?

Pignot, G.; Boulière, Fabien; Patard, Jean‐Jacques

doi:10.1016/j.eururo.2010.07.002

Cited by 16 publications

(6 citation statements)

References 12 publications

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“…12,13 A variety of methods to reduce this ischemic insult have been described, including surface cooling (ice slush), intraarterial cooling perfusion techniques, manual compression, early unclamping, and hypotensive anesthesia. 5,14,15 These techniques can be logistically difficult to implement and are often limited to centers with high-volume patient recruitment. …”

Section: Discussionmentioning

confidence: 99%

Zero Ischemia Laparoscopic Partial Thulium Laser Nephrectomy

Thomas

Smyth²,

Hennessey³

et al. 2013

Journal of Endourology

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Section: Discussionmentioning

confidence: 99%

Zero Ischemia Laparoscopic Partial Thulium Laser Nephrectomy

Thomas

Smyth²,

Hennessey³

et al. 2013

Journal of Endourology

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“…Warm ischemia during laparoscopic partial nephrectomy is considered the most negative modifiable factor for this kind of surgery [5][6][7] . Traditionally, 30 minutes is considered the maximum safe time for renal warm ischemia.…”

Section: ■ Introductionmentioning

confidence: 99%

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

et al. 2017

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The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model 1 Acta Cir. Bras. 2017;32(5):334-341 Abstract Purpose: To investigate the glomerular number after different warm ischemia times. Methods: Thirty two pigs were assigned into four groups. Three groups (G10, G20, and G30) were treated with 10, 20, and 30 minutes of left renal warm ischemia. The sham group underwent the same surgery without renal ischemia. The animals were euthanized after 3 weeks, and the kidneys were collected. Right kidneys were used as controls. The kidney weight, volume, cortical-medullar ratio, glomerular volumetric density, volume-weighted mean glomerular volume, and the total number of glomeruli per kidney were obtained. Serum creatinine levels were assessed pre and postoperatively. Results: Serum creatinine levels did not differ among the groups. All parameters were similar for the sham, G10, and G20 groups upon comparison of the right and left organs. The G30 group pigs' left kidneys had lower weight, volume, and cortical-medullar ratio and 24.6% less glomeruli compared to the right kidney. A negative correlation was found between warm ischemia time and glomerular number. Conclusions: About one quarter of glomeruli was lost after 30 minutes of renal warm ischemia. No glomeruli loss was detected before 20 minutes of warm ischemia. However, progressive glomerular loss was associated with increasing warm ischemia time.

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“…Warm ischemia was identified as the “ultimate enemy” for partial nephrectomy [ 20 ], and several methods to ameliorate its negative aspects have been proposed [ 5 – 8 ]. Although mannitol is largely employed for this purpose [ 9 ], its effects for ischemia protection during partial nephrectomy were only recently investigated [ 10 , 11 ].…”

Section: Discussionmentioning

confidence: 99%

Mannitol reduces nephron loss after warm renal ischemia in a porcine model

et al. 2018

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BackgroundMannitol has been employed to ameliorate renal warm ischemia damage during partial nephrectomy, however, there is limited scientific evidence to support the use of mannitol during partial nephrectomy. The objective of the present study was to investigate the glomerular number after renal warm ischemia, with and without the use of mannitol in a Pig Model.MethodsTwenty-four male pigs were assigned into three groups. Eight animals were allocated to the sham group that was subjected to laparoscopic dissection of the left renal hilum, without renal ischemia. Eight animals were allocated to the ischemia group that had the left renal hilum clamped for 30 min through laparoscopic access. Eight animals received mannitol (250 mg/kg) before the occlusion of renal hilum for 30 min. The kidneys were collected after the euthanasia of the pigs 21 days post surgery. The right kidney was utilized as a self-control for each animal. Serum creatinine, urea levels, the weight and volume of the kidneys were measured. Glomerular volumetric density, volume-weighted glomerular volume, and cortical volume were quantified through stereological methods and employed to determine the number of nephrons per kidney. Student’s t test and ANOVA were used for statistical analysis.ResultsIn the ischemia group, the left kidney recorded a reduction of 24.6% (290, 000 glomeruli) in the number of glomeruli in comparison to the right kidney. Kidneys subjected to ischemia also displayed decreased weight and volume in comparison to the sham and mannitol groups. No difference was observed between the left and right kidneys from the sham and mannitol groups. Further, no distinction in serum creatinine and urea among the groups was observed.ConclusionThe use of mannitol significantly reduces nephron loss during warm ischemia in pigs.

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Warm Ischaemia: The Ultimate Enemy for Partial Nephrectomy?

Cited by 16 publications

References 12 publications

Zero Ischemia Laparoscopic Partial Thulium Laser Nephrectomy

Zero Ischemia Laparoscopic Partial Thulium Laser Nephrectomy

The relationship between renal warm ischemia time and glomerular loss. An experimental study in a pig model

Mannitol reduces nephron loss after warm renal ischemia in a porcine model

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