Open Access

ARTICLE

A comparison of kidney oxygenation profi les between partial and complete renal artery clamping during nephron sparing surgery in a porcine model

Karim Bensalah¹, Jay D. Raman^1,3, Ilia S. Zeltser¹, Aditya Bagrodia¹, Steven M. Lucas¹, Wareef Kabbani², Jeffrey A. Cadeddu¹

1 Department of Urology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
2 Department of Pathology, University of Texas Southwestern Medical Center, Dallas, Texas, USA
3 Division of Urology, Penn State Milton S. Hershey Medical Center, Hershey, Pennsylvania, USA
Address correspondence to Dr. Jeffrey A. Cadeddu, Dept. of Urology, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard J8-106, Dallas, TX 75204 USA

Canadian Journal of Urology 2009, 16(3), 4632-4638.

Abstract

Objective: To compare kidney oxygenation profiles between partial and complete renal artery clamping during nephron sparing surgery (NSS) in a porcine model.
Materials and methods: Twelve female farm pigs underwent a laparoscopic nephrectomy. Subsequently, an open partial nephrectomy was performed on the remaining kidney using either total (n = 6, TC) or partial (n = 6, PC) clamping of the renal artery. Real time renal partial oxygen pressure (rPO2) was monitored using a Licox probe (Integra, San Diego, CA). Creatinine levels were measured prior to open partial nephrectomy and on POD #3 and #7. The remaining kidney was harvested for pathologic evaluation.
Results: Compared to TC, the PC group demonstrated a more favorable renal oxygenation profile during the NSS. Specifically, rPO2 decreased less from baseline (58% versus 84%, p = 0.03), took a longer interval to nadir (23.1 min versus 8.7 min, p = 0.04), and experienced a more rapid recovery to maximal or baseline values (4.8 min versus 10.4 min, p = 0.03) in the PC group. Furthermore animals undergoing TC had significantly higher creatinine levels at POD #3 (2.2 mg/dl versus 1.6 mg/dl, p = 0.03) and POD #7 (2.5 mg/dl versus 1.7 mg/dl, p = 0.009). Histological analysis demonstrated varying levels of acute inflammation in the two groups. Finally, the intraoperative blood loss was greater in the PC versus TC group (40 cc versus 10 cc, p = 0.04).
Conclusions: In this porcine model, partial clamping of the renal artery during NSS was feasible and demonstrated a favorable renal oxygenation profile. Theoretically, intraoperative rPO2 monitoring may provide a novel means to allow real time assessment and titration of kidney perfusion during partial nephrectomy.

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