Cold-ischemia technique during robot-assisted partial nephrectomy: Perioperative results, functional and oncological outcomes with one-year follow-up

PE17 Cold-ischemia technique during robot-assisted partial nephrectomy: Perioperative results, functional and oncological outcomes with one-year follow-up Porpiglia F., Bertolo R.G., Amparore D., Checcucci E., Mele F., Morra I., Di Dio M., Fiori C. San Luigi Gonzaga Hospital, Dept. of Urology, Orbassano, Italy INTRODUCTION & OBJECTIVES: In the setting of conservative treatment of complex renal masses, more complex resection and renorrhaphy phases could lead to longer ischemia time. In such cases, the cooling of the kidney (the so called “cold ischemia technique”, CIT) could be helpful in increasing kidney tolerance to ischemia. The matter of the technique is reproducibility in minimally-invasive surgery. We previously presented our practical approach to duplicate CIT during robot-assisted partial nephrectomy (RAPN). The aim of the study was to present perioperative, functional and oncological results after RAPN performed by using our CIT. MATERIAL & METHODS: Our indications to CIT RAPN were very challenging renal masses with extreme indication to nephron-sparing surgery. RAPN was performed by using Da Vinci SiHD system with 4-arms configuration. As described, after the procedure has started, an assistant began the slashing of the chilled sterile saline solution by a hip-milling machine. Once the renal pedicle and the kidney were isolated, a 15 mm port was inserted. Some 12 mm ports were filled with the slashed ice, then they were inserted into the 15 mm port and the ice was pushed intra-corporeally by the trocar at the level of the renal lodge. Once a satisfactory amount of ice was introduced, renal artery was clamped. Once cooling of the kidney was sufficient as showed by the thermal probe for monitoring, the extirpative phase started. At the end, renal defect was sutured and the renal clamp removed. Demographic and perioperative data were collected; complications were recorded and classified according to the Clavien System. Renal function was assessed by eGFR (MDRD formula) and renal scan performed within a month before the intervention at 3 months postoperatively. eGFR was assessed at 6 and 12 months postoperatively too. RESULTS: Ten patients were treated. Mean lesion size was 40 mm, median PADUA score 11. Operative time was 170 minutes; mean cold ischemia time was 30 minutes. The intraoperative mean renal parenchyma nadir temperature was 18°. Estimated blood losses were 130 ml. No intraoperative complications were recorded. 2 patients (20%) experienced grade II complications (blood transfusions). Median length of hospital stay was 5 days. No positive surgical margins were found. Mean eGFR drop at 3 months was 13 ml/min x1.73 m 2. In one patient a stage migration was recorded. The results were confirmed at 6 and 12 months of follow up. Concerning renal scan’s data, mean drop of effective renal plasma flow of the operated kidney at 3rd month postoperatively was 22%. At 12 months follow-up no patients experienced recurrences. CONCLUSIONS: In our experience, the proposed technique to duplicate cold ischemia in minimally-invasive nephronsparing surgery seemed to be feasible and safe. Perioperative results were good and functional results were encouraging in a cohort of patients with challenging renal masses who experienced ischemia time over 25 minutes.

Eur Urol Suppl 2016; 15(7):235