V9-05: Robotic Partial Nephrectomy with Intracorporeal Renal Hypothermia Using Ice Slush
VideoIntroductions and Objectives
To describe and outline our step-by-step technique for transperitoneal intracorporeal renal cooling using ice slush during robotic partial nephrectomy (RPN) and to present our 6-month functional outcomes.
24 patients underwent robotic partial nephrectomy with intracorporeal cooling. In our technique, patients are placed in the modified flank position and ports are placed as our previously described RPN. The insertion of a 12 mm laparoscopic port along the mid-axillary line below the costal margin allows for the introduction of a renal temperature probe and placement of slush directly behind and onto the kidney. Modified 20 cc syringes, are prefilled with ice slush and used for instilling the ice through the accessary 12 mm port. Renal temperature is monitored in real time with the use of a thermocoupler. Inclusion criteria for our study included cases where warm ischemia was estimated to take greater than 20 minutes.
Key strategies for successful intracorporeal renal parenchymal cooling consist of: (1) placement of accessory 12 mm port directly over the kidney, (2) placement of needle thermocoupler into renal parenchyma for real-time renal temperature monitoring, (3) rapid filling and delivery of slush, (4) sequential clamping of renal artery and vein to achieve optimal renal hypothermia, (5) protection of the neighboring intestine with a laparoscopic sponge, and (6) complete mobilization of the kidney and placement of the ice over the psoas muscle and over the kidney. Mean tumor size was 4.2 cm with an average RENAL nephrometry score of 9. Mean preoperative eGFR was 75.1. 6-month follow up data was available for 13 patients. Average eGFR at 6-month follow up was 67.2, representing a mean decrease in 10.7%. Mean ipsilateral decrease in renal function on MAG-3 renal scan was 18.7%.
RPN with renal hypothermia with intracorporeal cooling using ice slush is technically feasible. Our described technique for introducing ice is very simple, effective and highly reproducible.