TY - JOUR
T1 - Comparison of Tissue Oxygenation Profiles Using 3 Different Methods of Vascular Control During Porcine Partial Nephrectomy
AU - Raman, Jay D.
AU - Bensalah, Karim
AU - Bagrodia, Aditya
AU - Tracy, Chad R.
AU - Kabbani, Wareef
AU - Sagalowsky, Arthur I.
AU - Cadeddu, Jeffrey A.
N1 - Funding Information:
Karim Bensalah is supported by the Association Française d'urologie.
Copyright:
Copyright 2009 Elsevier B.V., All rights reserved.
PY - 2009/10
Y1 - 2009/10
N2 - Objectives: To compare oxygenation profiles and renal function outcomes between 3 methods of vascular control during porcine partial nephrectomy. Methods: To create a solitary kidney model, 18 pigs were subjected to a laparoscopic nephrectomy. Following a 7-day recovery, a contralateral open partial nephrectomy was performed with vascular control by either total renal artery clamping (TRAC, n = 6), partial renal artery clamping (PRAC, n = 6), or selective renal parenchymal clamping (SRPC, n = 6). Renal partial oxygen pressure (rPO2) was monitored using a Licox probe. Serum creatinine was assessed on day 0 and postoperative days 3 and 7. Pigs were sacrificed on the seventh day and the kidney sent for pathological examination. Results: Intraoperative oxygenation profiles demonstrated a lower percentage decline (P = .01), longer interval to nadir (P = .04), improved percentage recovery of baseline rPO2 (P = .04), and a shorter duration to recover baseline rPO2 (P = .03) in the PRAC and SRPC groups than in the TRAC. Despite not occluding the renal vasculature, the SRPC group experienced declines in rPO2 profiles of almost 50% from baseline. Serum creatinine levels increased significantly more in the TRAC group at days 3 and 7 (P = .04 and .01, respectively). Histological examination demonstrated patchy inflammation of parenchyma in all groups. Conclusions: The rPO2 monitoring may provide a novel means to allow real-time assessment and titration of kidney perfusion during partial nephrectomy. PRAC and SRPC demonstrate favorable renal oxygenation profiles compared with TRAC. Interestingly, SRPC kidneys experienced a significant decline in tissue oxygenation profiles. Further work is necessary to better delineate the mechanism underlying this decline.
AB - Objectives: To compare oxygenation profiles and renal function outcomes between 3 methods of vascular control during porcine partial nephrectomy. Methods: To create a solitary kidney model, 18 pigs were subjected to a laparoscopic nephrectomy. Following a 7-day recovery, a contralateral open partial nephrectomy was performed with vascular control by either total renal artery clamping (TRAC, n = 6), partial renal artery clamping (PRAC, n = 6), or selective renal parenchymal clamping (SRPC, n = 6). Renal partial oxygen pressure (rPO2) was monitored using a Licox probe. Serum creatinine was assessed on day 0 and postoperative days 3 and 7. Pigs were sacrificed on the seventh day and the kidney sent for pathological examination. Results: Intraoperative oxygenation profiles demonstrated a lower percentage decline (P = .01), longer interval to nadir (P = .04), improved percentage recovery of baseline rPO2 (P = .04), and a shorter duration to recover baseline rPO2 (P = .03) in the PRAC and SRPC groups than in the TRAC. Despite not occluding the renal vasculature, the SRPC group experienced declines in rPO2 profiles of almost 50% from baseline. Serum creatinine levels increased significantly more in the TRAC group at days 3 and 7 (P = .04 and .01, respectively). Histological examination demonstrated patchy inflammation of parenchyma in all groups. Conclusions: The rPO2 monitoring may provide a novel means to allow real-time assessment and titration of kidney perfusion during partial nephrectomy. PRAC and SRPC demonstrate favorable renal oxygenation profiles compared with TRAC. Interestingly, SRPC kidneys experienced a significant decline in tissue oxygenation profiles. Further work is necessary to better delineate the mechanism underlying this decline.
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U2 - 10.1016/j.urology.2009.05.018
DO - 10.1016/j.urology.2009.05.018
M3 - Article
C2 - 19628267
AN - SCOPUS:70349445406
SN - 0090-4295
VL - 74
SP - 926
EP - 931
JO - Urology
JF - Urology
IS - 4
ER -