V7-12: Evolution of regional hypothermia in robotic kidney surgery
VideoIntroductions and Objectives
Renal hypothermia has been used during open partial nephrectomy to help preserve renal function. Several techniques have been described to achieve renal hypothermia using a minimally invasive approach, but technical challenges have prevented widespread use. In this video, we demonstrate the evolution of a reproducible technique for achieving renal hypothermia during robotic kidney surgery.
Ice-cold saline irrigation and topical ice slush application were used to achieve renal hypothermia. A GelPOINT access port was used for ice delivery. Following hilar clamping, ice slush was introduced through a GelPOINT and applied over the kidney surface using modified disposable syringes, a sigmoidoscope, and a custom made ice syringe. An endoscopic bag placed over the kidney helped contain the ice slush during transperitoneal procedures. Renal parenchymal and core body temperatures were monitored by using thermal probes.
A total of 10 patients underwent robotic renal procedures using ice slush hypothermia (partial nephrectomy n=7, anatrophic nephrolithotomy n=3). The results are summarized in Table 1. There were no intraoperative or postoperative complications. Renal parenchymal temperatures of 1°C in the core body temperature during any procedures.
Cold ischemia during complex robotic kidney procedures is feasible and reproducible.