Comparison Of Perioperative Outcomes Between Renal Hypothermia And Normothemia In Laparoscopic Partial Nephrectomy

Objectives: To analysis the safety and feasibility of renal hypothermia in laparoscopic partial nephrectomy.Methods: 56 cases of renal tumor underwent RLPN(retroperitoneal laparoscopic partial nephrectomy) in Fujian Provincial Hospital from Dec. 2012 to Jan. 2015 were retrospectively collected. All cases were performed by the same surgeon. They were divided into Hypothermia group(28 cases) and Normothermia group(28 cases) according to whether the kidney was cooled. The gender, age, body mass index, tumor side and the biggest size of the tumor of the two groups were comparable. The perioperative parameters were compared between the two groups.Results: The average renal artery occlusion time of Hypothermia group and Normothermia group was 32.1±6.7min and 28.7±5.8min, respectively. The difference was statistically significant(P=0.042 < 0.05), and the renal ischemia time of Normothermia group was longer than Hypothermia group’s. The average operating time of Hypothermia group and Normothermia group was 191.9±55.0min and 191.9±34.6min, and the average loss of blood of them was 65±66ml and 81±63ml, respectively. The difference was not significant between the two groups(P > 0.05). The difference of the average recovery time of postoperative bowel function(42±20.3h and 43±13.6h), the time to ambulation after surgery(4.3±0.9d、4.2±1.1d), the removal time of urethral catheter(6.4±1.5d and 6±1.3d), the removal time of the drainage tube(6.8±2.1d and 6.5±2.4d) and the postoperative hospitalization time(8.9±2.8d and 8.4±2.5d) of Hypothermia group and Normothermia group was not statistically significant(P>0.05). However, the difference of the total amount of drainage between Hypothermia group and Normothermia group(510±179ml、354±164ml)was statistically significant(P=0.002 < 0.05). The total amount of drainage of Hypothermia group was more than Normothermia group’s. The postoperative complication rate ofHypothermia group and Normothermia group was 10.7%(3 cases), 14.3%(4 cases). 3 cases(10.7%) of Hypothermia group had urological complications including one renal subcapsular hemorrhage, one intraoperative bleeding needed transfusion and one positive surgical margin. Normothermia group had 1 case(3.6%) of urological complications which was urine leakage. The difference of complications rate was not significant between the two groups(P>0.05). The serum creatinine rise between preoperation and postoperation of Hypothermia group and Normothermia group was 28.5±21.0umol/l and 19.3±20.4umol/l, and the percentage reductions of e GFR before and after operation of Hypothermia group and Normothermia group were 24.8% and 19.2%, respectively. The difference of them was not statistically significant. There was no significant difference of the change of the blood urea nitrogen and the hemoglobin before and after operation in the two groups(P>0.05).Conclusions: The perioperative outcomes between renal hypothermia and the normothermia method in laparoscopic partial nephrectomy are comparable and renal hypothermia doesn’t increase the incidence of complications. Renal hypothermia is a safe and feasible technique. However, its effect on long-term renal function deserves further longer follow-up study.