US researchers report the success and feasibility of a novel method of carrying out partial nephrectomy in kidney patients, using minimally invasive surgery.
The procedure involves injecting ice slush onto the kidney through a Gelpoint access port (Applied Medical Resources Corp, Rancho Santa Margarita, California, USA), without losing insufflation or extending an incision, and allowing the surgeon to remove the tumor and inspect it at the operating table.
"Before, with a minimally invasive partial nephrectomy, it was very hard to get ice in through the small incision and to get the ice to stay where you want it. And then once the tumor's cut out, you really can't take it out of the body right away and look at it," explained lead author Craig Rogers (Henry Ford Health System, Detroit, Michigan) in a press release.
With Rogers and colleagues' method; however, "we can remove the tumor as soon as it's excised through the Gelpoint, look at it and decide if we're happy with what's been removed," he added, an advantage traditionally reserved for open surgery.
In all, seven individuals with kidney cancer who underwent the procedure formed the study cohort, of whom two were treated with a retroperitoneal approach and five with a transperitoneal approach.
Overall, approximately 400 mL ice was delivered in all patients within 3-4 min and renal parenchymal temperatures of less than 16.0ºC were achieved within 7 min of cold ischemia. No patients experienced a drop in core body temperature of more than 0.5ºC, note the researchers in European Urology.
The 1-month minimum follow-up data indicated no postoperative complications, a mean estimated glomerular filtration rate (indicating the flow of filtered fluid flowing through the kidneys) of 74.1 mL/min per 1.73 m2, and a median length of hospital stay of 2.3 days.
The authors explain that one of the barriers to broader uptake of partial nephrectomy for kidney cancer is the time constraints associated with warm ischemia. Once the blood supply to the kidney has been cut off, there are only about 30 minutes before the kidney undergoes irreversible damage, noted Rogers.
As in open surgery, packing the kidney with ice through the Gelpoint during clamping induces renal hypothermia, which allows the surgeon to "extend the window of time he has to work without kidney damage," he said in the statement.
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