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95 Impact of warm ischemia during laparoscopic partial nephrectomy on experimental solitary kidney animal model: Doppler ultrasonography assessment
95
Impact of warm ischemia during laparoscopic partial nephrectomy on experimental solitary kidney animal model: Doppler ultrasonography assessment Eur Urol Suppl 2014;13;e95
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Diez Farto S. 1 , Morcillo-Martín E. 2 , Rioja Zuazu J.P.3 , Sánchez Hurtado M.A.4 , Díaz-Güemes Martín-Portugués I.4 , Sánchez Margallo F.M.4 , Rodríguez-Rubio F.1 , Soria Galvez F.4 1 Univeristy
Hospital Puerto Real, Dept. of Urology, Cadiz, Spain, 2 Minimally Invasive Center "Jesús Usón", Dept. of Endoscopy, Cáceres,
Spain, 3 Hospital Universitarrio Miguel Servet, Dept. of Urology, Zaragoza, Spain, 4 Minimally Invasive Center "Jesús Usón", Dept. of Laparoscopic Surgery, Cáceres, Spain INTRODUCTION & OBJECTIVES: To compare haemodynamic Doppler Ultrasound parameters, Resistance Index (IR) Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV) and Renal Artery Flow (FR) after laparoscopic partial nephrectomy (LPN) in a mono-kidney animal model, and analyse the difference between two groups: Conventional technique (renal artery clamping) and KTP Laser (nonclamping). MATERIAL & METHODS: 30 white large pigs, 30 kg weight were used. Study is divided in 4 phases: -Phase I: After ruling out collecting system abnormalities, study parameters were determined at T 0 : IR,PSV, EDV and FR. Immediately after, a right laparoscopic radical nephrectomy was performed, in order to make the animal mono-kidney -Phase II: After four weeks, study parameters were measured (T 1 ) and animals were randomized to either conventional partial nephrectomy (Group 1) or KTP laser partial nephrectomy (Group 2) Study parameters were measured at the end of the procedure (T 2 ) (partial nephrectomy) and 30 min. after surgery. -Phase III and IV are follow up at 3(T4 ) and 6 weeks (T 5 ) after partial nephrectomy, with study parameters measurement. RESULTS: All the study parameters experience and increase between T 0 y T 1 (p>0,05) measurements at post partial nephrectomy T 2 released a decrease in all parameters in Group 1 when compared with Group 2 (p>0,001) these differences disappear at T3. During follow up T4 and T5 there is an increase tendency compared to T0, with better parameters for the clamping group
IR (T1) Pre-nephrectomy
IR (T2) IR (T3) IR (T4) Pre-nephrectomy Post-nephrectomy Follow-up
IR (T5) Final
Conventional 0,49±0,01
0,52±0,01
0,33±0,02
0,47±0,02
0,59±0,03
0,53±0,02
Laser
0,49±0,01
0,53±0,02
0,45±0,03
0,61±0,06
0,58±0,03
0,56±0,02
P value
p=0,003
p=0,002
PSV Initial (T0)
PSV (T1) Pre-nephrectomy
PSV (T2) PSV(T3) PSV (T4) Pre-nephrectomy Post-nephrectomy Follow-up
PSV(T5) Final
Conventional 34,06±0,01
36,87±3,42
20,08±0,52
25,04±1,77
41,83±3,94
33,72±2,38
Laser
33,06±1,18
33,05±3,17
28,16±3,06
13,71±0,59
20,60±2,05
17,26±1,23
P value
p=0,017
EDV Initial (T0)
EDV (T2) EDV (T1) Pre-nephrectomy Pre-nephrectomy
IR Initial (T0)
Conventional 15,51±1,11
17,5±1,61
13,45±0,57
13,71±0,59
20,60±2,05
17,26±1,23
Laser
16,96±1,55
19,49±2,02
14,89±1,01
16,34±1,55
17,87±0,99
17,45±1,59
P value
Flow Initial (T0)
Flow (T1) Flow (T2) Pre-nephrectomy Pre-nephrectomy
Conventional 124,5±13,15
221,07±25,79
74,11±3,78
162±12,91
337,48±43,44 342,87±49,94
Laser
98,72±10,11
268,63±45,06
119,53±5,81
132,84±26,70
170,84±27,67 130,20±24,44
P value
p=0,000
p<0,0001
P<0,0001
CONCLUSIONS: LPN with renal artery clamping has haemodynamic consequences when compared with non-clamping technique. Ischaemia decrease inmediate flow, but it improves long term flow parameters.
Impact of warm ischemia during laparoscopic partial nephrectomy on experimental solitary kidney animal model: Doppler ultrasonography assessment Eur Urol Suppl 2014;13;e95
Print! Print!
Diez Farto S. 1 , Morcillo-Martín E. 2 , Rioja Zuazu J.P.3 , Sánchez Hurtado M.A.4 , Díaz-Güemes Martín-Portugués I.4 , Sánchez Margallo F.M.4 , Rodríguez-Rubio F.1 , Soria Galvez F.4 1 Univeristy
Hospital Puerto Real, Dept. of Urology, Cadiz, Spain, 2 Minimally Invasive Center "Jesús Usón", Dept. of Endoscopy, Cáceres,
Spain, 3 Hospital Universitarrio Miguel Servet, Dept. of Urology, Zaragoza, Spain, 4 Minimally Invasive Center "Jesús Usón", Dept. of Laparoscopic Surgery, Cáceres, Spain INTRODUCTION & OBJECTIVES: To compare haemodynamic Doppler Ultrasound parameters, Resistance Index (IR) Peak Systolic Velocity (PSV), End Diastolic Velocity (EDV) and Renal Artery Flow (FR) after laparoscopic partial nephrectomy (LPN) in a mono-kidney animal model, and analyse the difference between two groups: Conventional technique (renal artery clamping) and KTP Laser (nonclamping). MATERIAL & METHODS: 30 white large pigs, 30 kg weight were used. Study is divided in 4 phases: -Phase I: After ruling out collecting system abnormalities, study parameters were determined at T 0 : IR,PSV, EDV and FR. Immediately after, a right laparoscopic radical nephrectomy was performed, in order to make the animal mono-kidney -Phase II: After four weeks, study parameters were measured (T 1 ) and animals were randomized to either conventional partial nephrectomy (Group 1) or KTP laser partial nephrectomy (Group 2) Study parameters were measured at the end of the procedure (T 2 ) (partial nephrectomy) and 30 min. after surgery. -Phase III and IV are follow up at 3(T4 ) and 6 weeks (T 5 ) after partial nephrectomy, with study parameters measurement. RESULTS: All the study parameters experience and increase between T 0 y T 1 (p>0,05) measurements at post partial nephrectomy T 2 released a decrease in all parameters in Group 1 when compared with Group 2 (p>0,001) these differences disappear at T3. During follow up T4 and T5 there is an increase tendency compared to T0, with better parameters for the clamping group
IR (T1) Pre-nephrectomy
IR (T2) IR (T3) IR (T4) Pre-nephrectomy Post-nephrectomy Follow-up
IR (T5) Final
Conventional 0,49±0,01
0,52±0,01
0,33±0,02
0,47±0,02
0,59±0,03
0,53±0,02
Laser
0,49±0,01
0,53±0,02
0,45±0,03
0,61±0,06
0,58±0,03
0,56±0,02
P value
p=0,003
p=0,002
PSV Initial (T0)
PSV (T1) Pre-nephrectomy
PSV (T2) PSV(T3) PSV (T4) Pre-nephrectomy Post-nephrectomy Follow-up
PSV(T5) Final
Conventional 34,06±0,01
36,87±3,42
20,08±0,52
25,04±1,77
41,83±3,94
33,72±2,38
Laser
33,06±1,18
33,05±3,17
28,16±3,06
13,71±0,59
20,60±2,05
17,26±1,23
P value
p=0,017
EDV Initial (T0)
EDV (T2) EDV (T1) Pre-nephrectomy Pre-nephrectomy
IR Initial (T0)
Conventional 15,51±1,11
17,5±1,61
13,45±0,57
13,71±0,59
20,60±2,05
17,26±1,23
Laser
16,96±1,55
19,49±2,02
14,89±1,01
16,34±1,55
17,87±0,99
17,45±1,59
P value
Flow Initial (T0)
Flow (T1) Flow (T2) Pre-nephrectomy Pre-nephrectomy
Conventional 124,5±13,15
221,07±25,79
74,11±3,78
162±12,91
337,48±43,44 342,87±49,94
Laser
98,72±10,11
268,63±45,06
119,53±5,81
132,84±26,70
170,84±27,67 130,20±24,44
P value
p=0,000
p<0,0001
P<0,0001
CONCLUSIONS: LPN with renal artery clamping has haemodynamic consequences when compared with non-clamping technique. Ischaemia decrease inmediate flow, but it improves long term flow parameters.