The Evaluation Of A Novel Technique For In Situ Cold Perfusion In Laparoscopic Partial Nephrectomy

Background: We present our technique, results and experience with in situ continuous cold perfusion of the kidney during retroperitoneal laparoscopic partial nephrectomy (RLPN). Materials and Methods: From October 2012 to March 2015, RLPN was performed in 53 patients (the novel technique group). Of these, 5 patients had a solitary kidney, renal failure in the opposite kidney, or higher preoperative serum creatinine (Cr) levels. Cold ischemia was achieved by continuous perfusion of Ringer's lactate solution at 4 degrees C through the renal artery, which was clamped proximally and pierced directly with a needle. Cold perfusion was initiated via the needle at a rate of 40 ml/min and 2 minutes later, decreased to 15 ml/min. The perfusate was infused into the systemic circulation via the renal veins. Thirty minutes later, 10 mg of furosemide was administered intravenously. The tumor was resected in a bloodless field. After repair of the renal defect, the perfusion was terminated, the needle was withdrawn, the bulldog clamp was removed, and arterial blood flow was reestablished. The patient's vital signs were observed throughout each surgery. The ischemia time and postoperative complications were recorded. Renal function was assessed with Cr values after each surgery, and an ultrasound was performed on the patients to scan the kidneys 6 months postoperatively. Patients (n = 30) who underwent the same surgery without in situ cold perfusion in the same center between June 2010 and June 2012 were reviewed for inclusion in the control group. Data on ischemia time and postoperative Cr levels in the two groups were collected for comparison. Results: All the procedures were successfully completed laparoscopically using the new technique. During the surgeries, no arrhythmia or hemorrhage was observed. No postoperative acute renal failure, leakage of urine, or specific complications related to the perfusion technique were observed. A total of 41 patients (including 4 of the 5 patients described above) underwent at least 6 months of follow-up, and none required dialysis. After 6 months of follow-up, no renal atrophy ultrasound was detected, and the renal parenchymal echogenicity and vascular resistance index were normal. The mean (range) ischemia time in the novel technique group was 47 (24-79) min, significantly longer than the mean (range) in the control group 18 (8-21) min (P < 0.05), and the Cr levels showed no differences at different time points after surgery. Conclusion: With this technique, kidney hypothermia can be achieved quickly during RLPN, and the procedure can effectively preserve renal function with few complications. The approach is safe, less demanding, and especially suitable for patients with a solitary kidney, renal failure in the opposite kidney, or preoperative renal inadequacy.