Landman J, Rehman J, Sundaram CP, Bhayani S, Monga M, Pattaras JG, Gokden N, Humphrey PA, Clayman RV. Renal hypothermia achieved by retrograde intracavitary saline perfusion.
J Endourol 2002;
16:445-9. [PMID:
12396435 DOI:
10.1089/089277902760367386]
[Citation(s) in RCA: 68] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND AND PURPOSE
Hypothermia during vascular clamping protects the kidney from ischemia-induced nephron loss. Traditionally, cooling is achieved by packing the kidney in ice, which lowers the temperature of the rest of the surgical field as well, and the method cannot be used during laparoscopy. We evaluated the utility of a newly developed ureteral access system for circulating ice-cold saline.
MATERIALS AND METHODS
Domestic pigs underwent retrograde endoscopic cooling through an access sheath without (N = 2) or with (N = 3) renal artery occlusion, traditional ice-slush cooling with renal artery occlusion (N = 3), or occlusion without hypothermia (N = 3). Five days later, the pigs were sacrificed and the kidneys and ureters examined histologically.
RESULTS
Endoscopic cooling with renal artery occlusion and ice-slush cooling both produced renal hypothermia. The former produced medullary and cortical temperatures of 21.3 degrees C and 27.3 degrees C, respectively, and the latter medullary and cortical temperatures of 28.8 degrees C and 23.7 degrees C, respectively. Histologically, there were minimal changes in the first three groups, whereas venous congestion, multifocal chronic inflammation, and periarteriolar hemorrhage were seen after renal artery occlusion without hypothermia.
CONCLUSION
Retrograde endoscopic renal hypothermia is effective and requires no novel equipment or special surgical skills. Clinical application has not yet been attempted.
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