V1077: INTRACORPOREAL COOLING AND EXTRACTION TECHNIQUE OF ROBOTIC PARTIAL NEPHRECTOMY: RECAPITULATING THE OPEN APPROACH

Video

Introduction and Objectives
In this video we demonstrate a technique for achieving cold ischemia and early tumor assessment during robotic partial nephrectomy (RPN) that recapitulates the open approach.

Methods
We present a 64-year-old female with a 2 cm right posterolateral solid enhancing renal mass. She elected to undergo a robotic partial nephrectomy. We planned an intracorporeal cooling and extraction (I.C.E.) RPN technique for cold ischemia and early tumor assessment. We used a Gelpoint® access port to facilitate introduction of ice slush for cold ischemia and early tumor extraction for margin assessment. Sterile iced saline slush was created in a slush machine and large disposable syringes were modified by cutting off the nozzle end to make a wider opening and were prefilled with ice slush in preparation for rapid injection. Ice filled syringes were placed through the Gelpoint at the site of the removed assistant port which allowed injection of ice slush around the kidney. Repeated injections of ice slush was performed to cover the kidney surface. Tumor excision was performed immediately after ice slush delivery and ice slush could be reapplied as needed while on clamp.

Results
Cold ischemia time was 18 minutes and the patient had an uncomplicated post-operative stay. Final pathology confirmed renal cell carcinoma with negative margins. To date, we have performed our ICE RPN technique in 7 patients. Mean cold ischemia time was 20 minutes. Temperature probes confirmed renal parenchymal temperatures of 16 degrees Celsius within 7 minutes and no drop in core body temperature > 0.5 degrees. All margins were negative for cancer.

Conclusions
Our I.C.E. technique of intracorporeal cooling and extraction allows for cold ischemia and early specimen evaluation during robotic partial nephrectomy. The ability to recapitulate these features typically limited to an open approach may help expand indications of minimally invasive partial nephrectomy.

Funding: none