TY - JOUR
T1 - Renal hypothermia achieved by retrograde endoscopic cold saline perfusion
T2 - Technique and initial clinical application
AU - Landman, Jaime
AU - Venkatesh, Ramakrishna
AU - Lee, David
AU - Vanlangendonck, Richard
AU - Morissey, Kevin
AU - Andriole, Gerald L.
AU - Clayman, Ralph V.
AU - Sundaram, Chandru P.
PY - 2003/5/1
Y1 - 2003/5/1
N2 - We describe the technique and initial clinical results with application of a novel method to achieve renal parenchymal hypothermia using retrograde ureteral access. A 38-year-old man was scheduled to undergo an open right partial nephrectomy for renal cell carcinoma. Before the open procedure, a ureteral access sheath was advanced to the ureteropelvic junction under fluoroscopic guidance; through the access sheath, a 7.1F pigtail catheter was also advanced. After clamping the renal artery and vein, ice-cold saline (-1.7°C) was circulated through the access sheath and drained via the 7.1F pigtail catheter; renal cortical and medullary parenchymal temperatures were measured using thermocouples. This technique of intrarenal cooling achieved a renal cortical temperature of 24°C and a medullary temperature of 21°C. The endoscopic procedure required an additional 35 minutes of operation time to complete. Histopathologic investigation of the specimen revealed no associated damage to the ureteral urothelium from access sheath placement or to the collecting system urothelium from exposure to ice-cold saline irrigation. Retrograde endoscopic renal hypothermia is feasible and effective. The technique requires no novel equipment or special surgical skills. This method can be applied to patients undergoing open or laparoscopic complex renal ablative and reconstructive procedures that require renal hypothermia.
AB - We describe the technique and initial clinical results with application of a novel method to achieve renal parenchymal hypothermia using retrograde ureteral access. A 38-year-old man was scheduled to undergo an open right partial nephrectomy for renal cell carcinoma. Before the open procedure, a ureteral access sheath was advanced to the ureteropelvic junction under fluoroscopic guidance; through the access sheath, a 7.1F pigtail catheter was also advanced. After clamping the renal artery and vein, ice-cold saline (-1.7°C) was circulated through the access sheath and drained via the 7.1F pigtail catheter; renal cortical and medullary parenchymal temperatures were measured using thermocouples. This technique of intrarenal cooling achieved a renal cortical temperature of 24°C and a medullary temperature of 21°C. The endoscopic procedure required an additional 35 minutes of operation time to complete. Histopathologic investigation of the specimen revealed no associated damage to the ureteral urothelium from access sheath placement or to the collecting system urothelium from exposure to ice-cold saline irrigation. Retrograde endoscopic renal hypothermia is feasible and effective. The technique requires no novel equipment or special surgical skills. This method can be applied to patients undergoing open or laparoscopic complex renal ablative and reconstructive procedures that require renal hypothermia.
UR - http://www.scopus.com/inward/record.url?scp=0037963321&partnerID=8YFLogxK
U2 - 10.1016/S0090-4295(02)02566-9
DO - 10.1016/S0090-4295(02)02566-9
M3 - Article
C2 - 12736030
AN - SCOPUS:0037963321
SN - 0090-4295
VL - 61
SP - 1023
EP - 1025
JO - Urology
JF - Urology
IS - 5
ER -