G.G. Khareba, V.N. Lesovoy, D.V. Shchukin, N.N. Polyakov
Using intracorporeal hypothermic perfusion in removal of single kidney tumor with spread to the main renal vein
The paper presents the experience of using hypothermic cold perfusion of a kidney in situ when performing complex nephron-sparing surgery for a tumor of a single right kidney with spreading to the main renal vein. The technique of the operation included separate clamping on the renal artery and IVC in the area of the cavorenal segment. Then the renal artery was opened and cannulated, and a vena cava was opened as a longitudinal section. The kidney was washed with a solution of kustadiol cooled to 4 °C. Then we performed standard steps of kidney resection, removal of the arterial cannula and suturing of the renal artery and inferior vena cava (IVC) sections. The patient underwent extrarenal thrombectomy with reconstruction of the renal vein using a flap v. saphena magna. The time of cold ischemia was 76 minutes.
The main advantages of this approach are good visibility of the resection zone, bloodless surgical field and the possibility of long-term safe renal ischemia. To assess the effectiveness of perfusion hypothermic kidney protection in situ, further accumulation of experience in conducting these operations is required.