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Comparison of prolonged warm and cold ischemia on the solitary kidney during partial nephrectomy in a rabbit model

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Abstract

The aim of this study was to investigate the patterns of renal function recovery during partial nephrectomy (PN) on an experimental solitary kidney rabbit model and establish the upper tolerable time limits of applied ischemia. Forty-eight New Zealand rabbits underwent an open right nephrectomy and after 30 days, the animals were clustered into five groups (A, B, C, D, E). The first four groups received an open left PN, under different types of ischemia. Groups A (n = 8) and B (n = 10) were subjected to 90 and 60 min of warm ischemia (WI), respectively, while groups C (n = 10) and D (n = 10) received 90 and 120 min of cold ischemia (CI) with ice-slush cooling. Group E (n = 10) served as sham group. Serum determinations of creatinine (SCr) and BUN were recorded preoperatively and on postoperative days (POD) 1, 3, 6 and 15. The animals were euthanized and the remaining kidneys were harvested and evaluated microscopically. The type and duration of ischemia were statistically significant parameters (P < 0.001). Groups B, C and D exhibited a similar pattern of recovery from trial initiation to the 15th POD (P = 0.788 and P = 0.068, respectively). Group A was extremely differentiated, with 100% mortality caused by uremia. The microscopic findings were consistent to the serum biochemistry. In our solitary kidney rabbit model, the upper limits of tolerable WI seem to be set on 60 min. CI can safely preserve the model’s renal function—even up to 120 min.

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References

  1. Novick AC (2004) Laparoscopic and partial nephrectomy. Clin Cancer Res 10:6322–6327

    Article  Google Scholar 

  2. Gill IS, Matin SF, Desai MM, Kaouk JH, Steinberg A, Mascha E, Thornton J, Sherief MH, Strzempkowski B, Novick AC (2003) Comparative analysis of laparoscopic versus open partial nephrectomy for renal tumors in 200 patients. J Urol 170:64–68

    Article  PubMed  Google Scholar 

  3. Novick AC (1983) Renal hypothermia: in vivo and ex vivo. Urol Clin North Am 10(4):637–43

    PubMed  CAS  Google Scholar 

  4. Abukora F, Nambirajan T, Albqhami N, Leeb K, Jeschke S, Gschwendtner M, Janetschek G (2005) Laparoscopic nephron sparing surgery: evolution in a decade. Eur Urol 47:488–493

    Article  PubMed  Google Scholar 

  5. Janetschek G, Abdelmaksoud A, Bagheri F, Al-Zahrani H, Leeb K, Gschwendtner M (2004) Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol 171:68–71

    Article  PubMed  Google Scholar 

  6. Steffens J, Humke U, Ziegler M, Siemer S (2005) Partial nephrectomy with perfusion cooling for imperative indications: a 24-year experience. BJU Int 96:608–611

    Article  PubMed  Google Scholar 

  7. Beasley KA, Omar MA, Shaikh A, Bochinski D, Khakhar A, Izawa JI, Welch RO, Chin JL, Kapoor A, Luke PP (2004) Laparoscopic versus open partial nephrectomy. Urology 64(3):458–461

    Article  PubMed  Google Scholar 

  8. Thompson HR, Leibovich BC, Lohse CM, Zincke H, Blute ML (2005) Complications of contemporary open nephron sparing surgery: a single institution experience. J Urol 174(3):855–858

    Article  PubMed  Google Scholar 

  9. Steinberg AP, Kilciler M, Abreu SC, Ramani AP, Ng C, Desai MM, Kaouk JH, Gill IS (2004) Laparoscopic nephron-sparing surgery for two or more ipsilateral renal tumors. Urology 64(2):255–258

    Article  PubMed  Google Scholar 

  10. Desai M, Aron M, Gill IS (2005) Laparoscopic partial nephrectomy versus laparoscopic cryoablation for the small renal tumor. Urology 66:23–28

    Article  PubMed  Google Scholar 

  11. Bhayani S, Rha KH, Pinto PA Ong AM, Allaf ME, Trock BJ, Jarrett TW, Kavoussi LR (2004) Laparoscopic partial nephrectomy: effect of warm ischemia on serum creatinine. J Urol 172:1264–1266

    Article  PubMed  CAS  Google Scholar 

  12. Shekarriz B, Shah G, Upadhyay J (2004) Impact of temporary hilar clamping during laparoscopic partial nephrectomy on postoperative renal function: a prospective study. J Urol 172:54–57

    Article  PubMed  Google Scholar 

  13. Guilloneau B, Bermudez H, Gholami S El Fettouh H, Gupta R, Adorno Rosa J, Baumert H, Cathelineau X, Fromont G, Vallancien G (2003) Laparoscopic partial nephrectomy for renal tumor: single center experience comparing clamping and no clamping techniques of the renal vasculature. J Urol 169:483–486

    Article  Google Scholar 

  14. Saranchuk J, Touijer K, Hakimian P, Snyder ME, Russo P (2004) Partial nephrectomy for patients with a solitary kidney: the Memorial-Sloan-Kettering experience. BJU Int 94:1323–1328

    Article  PubMed  Google Scholar 

  15. Bhayani S, Allaf ME, Link RE Rao P, Varkarakis JM, Jarrett TW, Kavoussi LR (2004) Laparoscopic partial nephrectomy in patients with neoplasia in a solitary kidney. Urology 64(1):35–37

    Article  PubMed  Google Scholar 

  16. Adkins K, Chang SS, Cookson MS, Smith JA (2003) Partial nephrectomy safely preserves renal function in patients with a solitary kidney. J Urol 169:79–81

    Article  PubMed  Google Scholar 

  17. Fergany AF, Saad IR, Woo L, Novick AC (2006) Open partial nephrectomy for tumor in a solitary kidney: experience with 400 cases. J Urol 175:1630–1633

    Article  PubMed  Google Scholar 

  18. Thompson RH, Frank I, Lohse CM, Saad IR, Fergany A, Zincke H, Leibovich BC, Blute ML, Novick AC (2007) The impact of ischemia time during nephron sparing surgery on solitary kidneys: a multi-institutional study. J Urol 177:471–476

    Article  PubMed  Google Scholar 

  19. Ramani AP, Ryndin I, Lynch AC, Veetil Puthen TR (2006) Current concepts in achieving renal hypothermia during laparoscopic partial nephrectomy. BJU Int 97:342–344

    Article  PubMed  Google Scholar 

  20. Baldwin DD, Maynes LJ, Berger KA Desai PJ, Zuppan CW, Zimmerman GJ, Winkielman AM, Sterling TH, Tsai CK, Ruckle HC (2004) Laparoscopic warm ischemia in the solitary porcine kidney model. Urology 64(3):592–597

    Article  PubMed  Google Scholar 

  21. Laven B, Orvieto MA, Chuang MC Ritch CR, Murray P, Harland RC, Inman SR, Brendler CB, Shalhav AL (2004) Renal tolerance to prolonged warm ischemia time in a laparoscopic versus open surgery porcine model. J Urol 172(6):2471–2472

    Article  PubMed  Google Scholar 

  22. Orvieto MA, Tolhurst SR, Chuang MS Lyon MB, Ritch CR, Rapp DE, Shalhav AL (2005) Defining maximal renal tolerance to warm ischemia in porcine laparoscopic and open surgery model. Urology 66(5):1111–1115

    Article  PubMed  Google Scholar 

  23. Faarup P, Holstein-Rathlou NH, Norgaard T, Hegedus V (2004) Early segmental changes in ischemic acute tubular necrosis of the rat kidney. APMIS 112:192–200

    Article  PubMed  Google Scholar 

  24. Gohji K, Kamidono S, Yamanaka N (1990) Renal carcinoma in a solitary kidney. BJU 66:248–253

    Article  PubMed  CAS  Google Scholar 

  25. Stackl W, Hofmann E, Marberger M (1983) Is the solitary kidney a priviledged kidney? BJU 55:460–464

    PubMed  CAS  Google Scholar 

  26. Lyrdal F (1975) The effect of surgical trauma, ischaemia and ureteral occlusion on renal blood flow and function. Scand J Urol Nephrol 24:601

    Google Scholar 

  27. Ames CD, Venkatesh R, Weld KJ Morrissey K, Foyil KV, Shen T, Dryer S, Hruby G, Sutera SP, Landman J (2005) Laparoscopic renal parenchymal hypothermia with novel ice-slush deployment mechanism. Urology 66:33–37

    Article  PubMed  Google Scholar 

  28. Bilde T, Dahlager JI, Asnaes S, Jaglicic D (1977) The influence of warm ischaemia on renal function and pathology. Scand J Urol Nephrol 11:165–172

    Article  PubMed  CAS  Google Scholar 

  29. Kim SJ, Lim YT, Kim BS Cho SI, Woo JS, Jung JS, Kim YK (2000) Mechanism of reduced GFR in rabbits with ischemic acute renal failure. Ren Fail 22(2):129–141

    Article  PubMed  CAS  Google Scholar 

  30. Yossepowitch O, Eggener SE, Serio A Huang WC, Snyder ME, Vickers AJ, Russo P (2006) Temporary renal ischemia during nephron sparing surgery is associated with short-term but not long-term impairment in renal function. J Urol 176:1339–1343

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Urology, Athens University Medical School, “LAIKO” Hospital, 17 Ag. Thoma str., Athens, 11527, Greece

    S. I. Tyritzis, T. Manousakas, A. Zervas & C. Constantinides

  2. Department of Histology and Embryology, Athens University Medical School, Athens, Greece

    A. Kyroudi

  3. Department of Urology, Patras University Medical School, Rio, Patras, Greece

    E. Liatsikos

  4. Center for Experimental Surgery, Biomedical Research Foundation of the Academy of Athens, Athens, Greece

    P. Karayannacos & N. Kostomitsopoulos

  5. Department of Pathology, Athens University Medical School, Athens, Greece

    K. Pavlakis

  6. Department of Urology, University of Leipzig,  Leipzig, Germany

    J.-U. Stolzenburg

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  1. S. I. Tyritzis
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  2. A. Kyroudi
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  4. T. Manousakas
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  5. P. Karayannacos
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  6. N. Kostomitsopoulos
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  7. A. Zervas
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  9. J.-U. Stolzenburg
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  10. C. Constantinides
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Correspondence to S. I. Tyritzis.

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Tyritzis, S.I., Kyroudi, A., Liatsikos, E. et al. Comparison of prolonged warm and cold ischemia on the solitary kidney during partial nephrectomy in a rabbit model. World J Urol 25, 635–640 (2007). https://doi.org/10.1007/s00345-007-0214-3

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  • DOI: https://doi.org/10.1007/s00345-007-0214-3

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