Comparison of ischemic intermittent and continuous inflow occlusion during laparoscopic partial nephrectomy in the Porcine Model
The duration of renal ischemia is the largest modifiable risk factor during partial nephrectomy warm ischemia is associated with short-and long-term renal consequences. A primary goal of partial nephrectomy is to preserve as much renal function as possible. The objective of this study was to explore whether intermittent ischemia could reduce renal function injury during partial nephrectomy in the Porcine Model and explore the feasibility of application of intermittent ischemia in nephrectomy.
6 female pigs underwent Laparoscopic surgery, continuous ischemia was applied to one kidney, and intermittent ischemia to the other kidney in each pig. Each kidney underwent to laparoscopic renal artery occlusion for 120 min. Intermittent ischemia was applied in cycles of 15 min of ischemia and 3 min of reperfusion (15/3 min cycle). Renal function injures were assessed by microdialysis technique, immunohistochemistry and histopathological examination.
The glycerol concentration of the intermittent ischemia kidneys during ischemia was significantly less relative to the glycerol levels obtained from the kidneys subjected to continuous ischemia(F=19.06, p=0.001), both the renal tubular epithelial cell NGAL and BCL-2 immunostaining of the intermittent ischemia kidneys during ischemia was significantly low compared with the continuous ischemia kidneys(F=5.51 p=0.041; F=13.53 p?0.004). Histological examination confirmed the renal damage through several morphological parameters in each group.
We successfully establish a porcine kidney ischemia-reperfusion injury model. To our knowledge, there has been no animal study regarding the effect of intermittent ischemia in laparoscopic partial nephrectomy and comparison with continuous normothermic ischemia. Our study demonstrates that intermittent renal artery occlusion is a potentially effective and feasible method for the prevention of renal function injury in the Porcine Model.