Expands surgical window and indications for robotic procedures
In this video, Jihad Kaouk, MD, Director, Center for Robotic & Image-Guided Surgery at Cleveland Clinic’s Glickman Urological & Kidney Institute, demonstrates a novel kidney cooling technique that safely expands the time needed to reconstruct the kidney in a robotic partial nephrectomy.
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“Advances in robotic surgery have allowed for partial nephrectomy to be done in a minimally invasive fashion with outcomes comparable to the open technique. But robotic surgeons are constantly working against the clock, as prolongation of clamp time results in irreversible damage, usually after only 25 minutes,” Dr. Kaouk explains. Warm ischemia must be limited to less than 30 minutes.
Dr. Kaouk’s intracorporeal technique involves introducing ice slush as a reliable method of cooling the kidney that can extend the surgical window to up to an hour if needed.
“Ice cooling the kidney intracorporeally duplicates the advantages of open surgery, helping surgeons minimize excision of adjacent kidney tissue and thereby preserving kidney function and decreasing risk of dialysis. It also removes the pressure of time during robotic partial nephrectomy,” Dr. Kaouk says. “This technique is especially attractive for patients with solitary kidneys when longer ischemic time is indicated.”
Dr. Kaouk notes that ice cooling also expands indications for robotic partial nephrectomy to larger, more complex and even multiple tumors.
In the video, he describes a prospective study of 24 patients that were estimated to have a warm ischemia time of greater than 20 minutes. Surgeons monitored renal temperature with a thermocoupler and used the intracorporeal ice slush technique. In this study, the mean cold ischemia time was 30.8 minutes. The team demonstrated the technique’s feasibility and argue that it should be considered for patients with complex or multiple tumors, chronic kidney disease and/or solitary kidneys whenever warm ischemia time is estimated to exceed 30 minutes.
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