Renal hypothermia achieved by retrograde intracavitary saline perfusion

Background and Purpose: Hypothermia during vascular clamping protects the kidney from ischemia-induced nephron loss. Traditionally, cooling is achieved by packing the kidney in ice, which lowers the temperature of the rest of the surgical field as well, and the method cannot be used during laparoscopy. We evaluated the utility of a newly developed ureteral access system for circulating ice-cold saline. Materials and Methods: Domestic pigs underwent retrograde endoscopic cooling through an access sheath without (N = 2) or with (N = 3) renal artery occlusion, traditional ice-slush cooling with renal artery occlusion (N = 3), or occlusion without hypothermia (N = 3). Five days later, the pigs were sacrificed and the kidneys and ureters examined histologically. Results: Endoscopic cooling with renal artery occlusion and ice-slush cooling both produced renal hypothermia. The former produced medullary and cortical temperatures of 21.3°C and 27.3°C, respectively, and the latter medullary and cortical temperatures of 28.8°C and 23.7°C, respectively. Histologically, there were minimal changes in the first three groups, whereas venous congestion, multifocal chronic inflammation, and periarteriolar hemorrhage were seen after renal artery occlusion without hypothermia. Conclusion: Retrograde endoscopic renal hypothermia is effective and requires no novel equipment or special surgical skills. Clinical application has not yet been attempted.