Abstract：Objective:To introduce our initial experience in using renal artery cold perfusion in laparoscopic partial nephrectomy for complex renal tumor. Methods:From March 2013, 14 patients with complex renal tumor underwent partial nephrectomy combined with renal artery cold perfusion. The operations were carried out by the same surgeon using laparoscopic retroperitoneal approach (n=7) and robotic transperitoneal approach (n=7) . Results:Partial nephrectomy was successfully performed on 12 patients. incomplete arterial block occurred in 4 patients, and 2 patients underwent conversion to radical nephrectomy. There was no conversion to open surgery in all cases. Additionally, a mild renal dysfunction was identified in the 12 patients who underwent partial nephrectomy. Conclusions:Combination of renal artery cold perfusion with laparoscopic partial nephrectomy is feasible and safe for complex renal tumor. It can reduce the incidence of radical nephrectomy, as well as the damage of warm ischemia to renal function.
[1]Go AS, Chertow GM, Fan D, et al. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med, 2004,351(13):1296-1305. [2]Campbell SC, Novick AC, Belldegrun A, et al. Guideline for management of the clinical T1 renal mass. J Urol, 2009,182(4):1271-1279. [3]Ljungberg B, Bensalah K, Bex A, et al. Guidelines on renal cell carcinoma. European Association of Urology, 2013:33-35. [4]Gill IS, Kavoussi LR, Lane BR, et al. Comparison of 1,800 laparoscopic and open partial nephrectomies for single renal tumors. J Urol, 2007,178(1):41-46. [5]Lane BR, Gill IS. 7-year oncological outcomes after laparoscopic and open partial nephrectomy. J Urol, 2010,183(2):473-479. [6]夏国伟,孙传玉,丁强.腹腔镜肾部分切除术相关问题探讨.微创泌尿外科杂志.2012,1(1):6-8. [7]马鑫, 郑涛, 史涛坪, 等. 肾血管低温灌注下后腹腔镜肾部分切除术处理2例复杂左侧肾肿瘤. 微创泌尿外科杂志, 2013,2(3):222-224. [8]Phillips CK, Taneja SS, Stifelman MD. Robot-assisted laparoscopic partial nephrectomy: the NYU technique. J Endourol, 2005,19(4):441-445. [9]Huang WC, Levey AS, Serio AM, et al. Chronic kidney disease after nephrectomy in patients with renal cortical tumours: a retrospective cohort study. Lancet Oncol, 2006,7(9):735-740. [10]Lane BR, Campbell SC, Gill IS. 10-year oncologic outcomes after laparoscopic and open partial nephrectomy. J Urol, 2013,190(1):44-49. [11]Becker F, Van Poppel H, Hakenberg OW, et al. Assessing the impact of ischaemia time during partial nephrectomy. Eur Urol, 2009,56(4):625-634. [12]Gill IS, Abreu SC, Desai MM, et al. Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol, 2003,170(1):52-56. [13]Schoeppler GM, Klippstein E, Hell J, et al. Prolonged cold ischemia time for laparoscopic partial nephrectomy with a new cooling material: Freka-gelice-a comparison of four cooling methods. J Endourol, 2010,24(7):1151-1154. [14]Landman J, Rehman J, Sundaram CP, et al. Renal hypothermia achieved by retrograde intracavitary saline perfusion. J Endourol, 2002,16(7):445-449. [15]Janetschek G, Abdelmaksoud A, Bagheri F, et al. Laparoscopic partial nephrectomy in cold ischemia: Renal artery perfusion. J Urol, 2004,171(1):68-71. [16]Marberger M, Eisenberger F. Regional hypothermia of the kidney-surface or transarterial perfusion cooling-a functional-study. J Urol, 1980,124(2):179-183. [17]Marberger M, Georgi M, Guenther R, et al. Simultaneous balloon occlusion of renal-artery and hypothermic perfusion in insitu surgery of kidney. J Urol, 1978,119(4):463-467. [18]Steffens J, Humke U, Ziegler M, et al. Partial nephrectomy with perfusion cooling for imperative indications: a 24-year experience. BJU Int, 2005,96(4):608-611. [19]Wen J, Li HZ, Ji ZG, et al. Evaluation of retroperitoneoscopic partial nephrectomy with in situ hypothermic perfusion. Clin Transl Oncol, 2012,14(5):382-385. [20]Beri A, Lattouf JB, Deambros O, et al. Partial nephrectomy using renal artery perfusion for cold ischemia: functional and oncologic outcomes. J Endourol, 2008,22(6):1285-1290.
