Laparoscopic ice slush XXXX for partial nephrectomy: the initial experience.

@entity1 @entity8 @entity3816 @entity63 @entity190 @entity5 @entity1358 @entity703
PURPOSE: We describe a novel technique of laparoscopic @entity8 with intracorporeal ice slush during partial nephrectomy as well as clinical experience with the initial 12 @entity1 . MATERIALS AND METHODS: A total of 12 select @entity1 with an infiltrating @entity703 who were candidates for nephron sparing surgery underwent transperitoneal laparoscopic partial nephrectomy with @entity8 . An Endocatch II (United States Surgical Corp., Norwalk, Connecticut) bag was placed around the mobilized kidney and its drawstring was cinched around the intact renal hilum. The renal artery and vein were occluded en bloc with a Satinsky clamp. The bottom of the engaged bag was retrieved through a 12 mm port site and opened, and ice slush was introduced within the bag to completely surround the kidney. After @entity8 was achieved laparoscopic partial nephrectomy was performed by duplicating open surgical techniques. Renal parenchymal temperature was measured using a thermocouple needle in 5 @entity1 . Median @entity5 size was 3.2 cm (range 1.5 to 5.5), 6 @entity5 (50%) were central in location and an imperative indication for partial nephrectomy was present in 7 @entity1 (58%). RESULTS: All procedures were successfully completed laparoscopically without open conversion. Median time to deploy the bag around the kidney was 7 minutes (range 5 to 20), the median volume of ice slush introduced was 600 cc (range 300 to 750) and the time needed to insert the ice slush was 4 minutes (range 3 to 10). Median @entity190 was 200 cc, total @entity63 time was 43.5 minutes (range 25 to 55) and total operative time was 4.3 hours (range 3 to 5.5). Nadir renal parenchymal temperature was 5C to 19C and the mean decrease in systemic temperature was 0.6C. Histopathology confirmed @entity1358 in 11 @entity1 (92%), of whom all had negative surgical margins. @entity3816 occurred in 2 initial @entity1 , including partial bag slippage in 1 and Satinsky clamp malfunction in 1. Postoperatively renal scan confirmed a functioning ipsilateral kidney in all cases. CONCLUSIONS: To our knowledge we present the initial clinical report of laparoscopic @entity8 for partial nephrectomy. By replicating standard open surgical practice our intracorporeal ice slush technique has the potential to extend the scope of laparoscopic partial nephrectomy to more @entity703 .
