Laparoscopic radical partial nephrectomy of a renal tumour: Initial case report

Renal hypothermia achieved by retrograde endoscopic cold saline perfusion: technique and initial clinical application

We describe the technique and initial clinical results with application of a novel method to achieve renal parenchymal hypothermia using retrograde ureteral access. A 38-year-old man was scheduled to undergo an open right partial nephrectomy for renal cell carcinoma. Before the open procedure, a ureteral access sheath was advanced to the ureteropelvic junction under fluoroscopic guidance; through the access sheath, a 7.1F pigtail catheter was also advanced. After clamping the renal artery and vein, ice-cold saline (-1.7 degrees C) was circulated through the access sheath and drained via the 7.1F pigtail catheter; renal cortical and medullary parenchymal temperatures were measured using thermocouples. This technique of intrarenal cooling achieved a renal cortical temperature of 24 degrees C and a medullary temperature of 21 degrees C. The endoscopic procedure required an additional 35 minutes of operation time to complete. Histopathologic investigation of the specimen revealed no associated damage to the ureteral urothelium from access sheath placement or to the collecting system urothelium from exposure to ice-cold saline irrigation. Retrograde endoscopic renal hypothermia is feasible and effective. The technique requires no novel equipment or special surgical skills. This method can be applied to patients undergoing open or laparoscopic complex renal ablative and reconstructive procedures that require renal hypothermia.

Renal hypothermia achieved by retrograde intracavitary saline perfusion

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.

Effect of argon-beam coagulation on the integrity of suture material

PURPOSE

To evaluate the effect of argon-beam coagulator (ABC) energy on suture materials.

MATERIALS AND METHODS

Six absorbable and nonabsorbable suture materials (polyglactin, chromic catgut, polydioxanone, silk, poliglecaprone, and Gore-Tex) were placed under tension and exposed to ABC energy to determine breaking times. Subsequently, all suture materials were exposed to limited ABC energy, and tensiometry was used to determine decreases in breaking strengths.

RESULTS

Among the suture materials tested, Gore-Tex was the most resistant to ABC energy. Although absorbable suture materials were less resistant than nonabsorbable suture materials, 2-0 polyglactin manifested the greatest resiliance to deterioration with ABC energy exposure.

CONCLUSIONS

The ABC has differential effects on suture materials. Larger-gauge suture materials are more resistant to ABC than smaller materials. Similarly, nonabsorbable sutures are generally more resilient to ABC energy than absorbable materials. Among the suture materials evaluated in our in vitro model, 2-0 Gore-Tex was best suited for vascular ligation, and 2-0 polyglactin is optimal for renal collecting system closure if ABC is anticipated as an adjunct for hemostasis.