Evaluation of retroperitoneoscopic partial nephrectomy with in situ hypothermic perfusion.

Background: The objective of this study was to evaluate the clinical application value of in situ hypothermic perfusion of kidneys during retroperitoneal laparoscopic partial nephrectomy (RLPN).

Methods: We used in situ hypothermic perfusion of kidneys during RLPN in 12 patients with renal tumour. Renal arterial-catheterisation for temporary balloon occlusion of renal artery was used Hypothermic ischaemia was achieved by continuous perfusion of Ringer's solution at 4°C through the renal artery.The collecting system was repaired by 4/0 Dixon and renal reconstruction was performed by 1/0 Dixon.We compared data between the RLPN group and open partial nephrectomy (OPN) group.

Results: All RLPN operations were successfully completed. Ten of their pathological results were renal cell carcinoma, while two were reninoma and harmatoma respectively. Entry to the collecting system in two patients was repaired intraoperatively. No additional vascular repair was done. There were no significant postoperative complications. The renal function of the kidney was well preserved postoperatively. Neither local recurrence nor distant metastasis was found during the follow-up. There was a statistically significant difference in mean operative time and mean hypothermic ischaemia time between two groups. No difference was noted in mean tumour diameter, intraoperative blood loss, and preoperative and postoperative creatinine clearance rate.

Conclusions: The technique of incorporating hypothermic ischaemia via arterial perfusion into RLPN is feasible and safe, which expands the armamentarium of the urologist with the help of radiologists. It is of high clinical applied value, especially for the more complex nephron-sparing surgery.