Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique
Background: In partial nephrectomy for highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage. Objective: To describe our case series, surgical technique, and early outcomes for robot-assisted partial nephrectomy (RAPN) using int...
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | European Urology Open Science |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666168323017998 |
| _version_ | 1797391790909685760 |
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| author | Pieter De Backer Joris Vangeneugden Camille Berquin Saar Vermijs Peter Dekuyper Alexandre Mottrie Charlotte Debbaut Thierry Quackels Charles Van Praet Karel Decaestecker |
| author_facet | Pieter De Backer Joris Vangeneugden Camille Berquin Saar Vermijs Peter Dekuyper Alexandre Mottrie Charlotte Debbaut Thierry Quackels Charles Van Praet Karel Decaestecker |
| author_sort | Pieter De Backer |
| collection | DOAJ |
| description | Background: In partial nephrectomy for highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage. Objective: To describe our case series, surgical technique, and early outcomes for robot-assisted partial nephrectomy (RAPN) using intra-arterial cold perfusion through arteriotomy. Design, setting, and participants: A retrospective analysis was conducted of ten patients with renal tumors (PADUA score 9–13) undergoing RAPN between March 2020 and March 2023 with intra-arterial cooling because of expected arterial clamping times longer than 25 min. Surgical procedure: Multiport transperitoneal RAPN with full renal mobilization and arterial, venous, and ureteral clamping was performed. After arteriotomy and venotomy, 4°C heparinized saline is administered intravascular through a Fogarty catheter to maintain renal hypothermia while performing RAPN. Measurements: Demographic data, renal function, console and ischemia times, surgical margin status, hospital stay, estimated blood loss, and complications were analyzed. Results and limitations: The median warm and cold ischemia times were 4 min (interquartile range [IQR] 3–7 min) and 60 min (IQR 33–75 min), respectively. The median rewarming ischemia time was 10.5 min (IQR 6.5–23.75 min). The median pre- and postoperative estimated glomerular filtration rate values at least 1 mo after surgery were 90 ml/min (IQR 78.35–90 ml/min) and 86.9 ml/min (IQR 62.08–90 ml/min), respectively. Limitations include small cohort size and short median follow-up (13 [IQR 9.1–32.4] mo). Conclusions: We demonstrate the feasibility and first case series for RAPN using intra-arterial renal hypothermia through arteriotomy. This approach broadens the scope for minimal invasive nephron-sparing surgery in highly complex renal masses. Patient summary: We demonstrate a minimally invasive surgical technique that reduces kidney infarction during complex kidney tumor removal where surrounding healthy kidney tissue is spared. The technique entails arterial cold fluid irrigation, which temporarily decreases renal metabolism and allows more kidneys to be salvaged. |
| first_indexed | 2024-03-08T23:37:48Z |
| format | Article |
| id | doaj.art-738a2b06e42944f38eef2aa12ad1acc3 |
| institution | Directory Open Access Journal |
| issn | 2666-1683 |
| language | English |
| last_indexed | 2024-03-08T23:37:48Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | European Urology Open Science |
| spelling | doaj.art-738a2b06e42944f38eef2aa12ad1acc32023-12-14T05:23:48ZengElsevierEuropean Urology Open Science2666-16832023-12-01581927Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical TechniquePieter De Backer0Joris Vangeneugden1Camille Berquin2Saar Vermijs3Peter Dekuyper4Alexandre Mottrie5Charlotte Debbaut6Thierry Quackels7Charles Van Praet8Karel Decaestecker9Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium; IBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, Belgium; ORSI Academy, Melle, Belgium; Corresponding author. ORSI Academy, Proefhoevestraat 12, 9090 Melle, Belgium. Tel. +32 472 394 735.Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, BelgiumDepartment of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, BelgiumIBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, BelgiumDepartment of Urology, AZ Maria Middelares Hospital, Ghent, BelgiumORSI Academy, Melle, Belgium; Department of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, BelgiumIBiTech-Biommeda, Department of Electronics and Information Systems, Faculty of Engineering and Architecture, Ghent University, Ghent, BelgiumDepartment of Urology, Hôpital Erasme, Brussels, BelgiumDepartment of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, BelgiumDepartment of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium; Department of Urology, AZ Maria Middelares Hospital, Ghent, BelgiumBackground: In partial nephrectomy for highly complex tumors with expected long ischemia time, renal hypothermia can be used to minimize ischemic parenchymal damage. Objective: To describe our case series, surgical technique, and early outcomes for robot-assisted partial nephrectomy (RAPN) using intra-arterial cold perfusion through arteriotomy. Design, setting, and participants: A retrospective analysis was conducted of ten patients with renal tumors (PADUA score 9–13) undergoing RAPN between March 2020 and March 2023 with intra-arterial cooling because of expected arterial clamping times longer than 25 min. Surgical procedure: Multiport transperitoneal RAPN with full renal mobilization and arterial, venous, and ureteral clamping was performed. After arteriotomy and venotomy, 4°C heparinized saline is administered intravascular through a Fogarty catheter to maintain renal hypothermia while performing RAPN. Measurements: Demographic data, renal function, console and ischemia times, surgical margin status, hospital stay, estimated blood loss, and complications were analyzed. Results and limitations: The median warm and cold ischemia times were 4 min (interquartile range [IQR] 3–7 min) and 60 min (IQR 33–75 min), respectively. The median rewarming ischemia time was 10.5 min (IQR 6.5–23.75 min). The median pre- and postoperative estimated glomerular filtration rate values at least 1 mo after surgery were 90 ml/min (IQR 78.35–90 ml/min) and 86.9 ml/min (IQR 62.08–90 ml/min), respectively. Limitations include small cohort size and short median follow-up (13 [IQR 9.1–32.4] mo). Conclusions: We demonstrate the feasibility and first case series for RAPN using intra-arterial renal hypothermia through arteriotomy. This approach broadens the scope for minimal invasive nephron-sparing surgery in highly complex renal masses. Patient summary: We demonstrate a minimally invasive surgical technique that reduces kidney infarction during complex kidney tumor removal where surrounding healthy kidney tissue is spared. The technique entails arterial cold fluid irrigation, which temporarily decreases renal metabolism and allows more kidneys to be salvaged.http://www.sciencedirect.com/science/article/pii/S2666168323017998Partial nephrectomyRenal cell carcinomaIntra-arterial coolingIschemia timeThree-dimensional modelsRobot-assisted surgery |
| spellingShingle | Pieter De Backer Joris Vangeneugden Camille Berquin Saar Vermijs Peter Dekuyper Alexandre Mottrie Charlotte Debbaut Thierry Quackels Charles Van Praet Karel Decaestecker Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique European Urology Open Science Partial nephrectomy Renal cell carcinoma Intra-arterial cooling Ischemia time Three-dimensional models Robot-assisted surgery |
| title | Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique |
| title_full | Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique |
| title_fullStr | Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique |
| title_full_unstemmed | Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique |
| title_short | Robot-assisted Partial Nephrectomy Using Intra-arterial Renal Hypothermia for Highly Complex Endophytic or Hilar Tumors: Case Series and Description of Surgical Technique |
| title_sort | robot assisted partial nephrectomy using intra arterial renal hypothermia for highly complex endophytic or hilar tumors case series and description of surgical technique |
| topic | Partial nephrectomy Renal cell carcinoma Intra-arterial cooling Ischemia time Three-dimensional models Robot-assisted surgery |
| url | http://www.sciencedirect.com/science/article/pii/S2666168323017998 |
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