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ENDOUROLOGY
& LAPAROSCOPY
Current
Concepts in Achieving Renal Hypothermia during Laparoscopic Partial Nephrectomy
Ramani AP, Ryndin I, Lynch AC, Veetil RT
Section of Laparoscopic Surgery, Department of Urology, University of
Minnesota, Minneapolis, MN 55455, USA
BJU Int. 2006; 97: 342-4
- Objectives:
To review current methods of renal hypothermia during laparoscopic partial
nephrectomy.
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Methods:
Review paper describing different methods of renal hypothermia during
laparoscopic partial nephrectomy, including laparoscopic ice-slush,
endoscopic retrograde cold saline infusion, transarterial renal hypothermia,
laparoscopic cooling sheath and ancillary techniques for ischemic renoprotection.
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Conclusion:
Renal hypothermia is occasionally required during current laparoscopic
renal procedures. Of the various techniques available to achieve laparoscopic
renal hypothermia, the surface hypothermia achieved with ice-slush,
although cumbersome, duplicates open surgical time-tested principles
and is currently the preferred option. Better delivery systems for hypothermic
solutions are needed for optimum uniform cooling of the kidney.
- Editorial
Comment
This paper reviews the different methods of renal hypothermia during
laparoscopic partial nephrectomy and succinctly discusses the renal
physiology of hypothermia and protective mechanisms from ischemia-reperfusion
injury. Not all methods have been established yet. Recent published
large series of laparoscopic partial nephrectomy from different institutions
have demonstrated that renal functions, as well as, oncological outcomes
are comparable to open series without the need of renal hypothermia.
Although ablative and reconstructive laparoscopic surgery have been
growing and developing fast, fundamental questions remain unanswered;
i.e. the optimal method to prevent renal ischemia-reperfusion injury
when performing laparoscopic partial nephrectomy.
Dr.
Fernando J. Kim
Chief of Urology, Denver Health Med Ctr
Assistant Professor, Univ Colorado Health Sci Ctr
Denver, Colorado, USA |