Nephron-sparing surgery: the effect of surface cooling and temporary renal artery occlusion on renal function.

Aims: To evaluate whether transient renal artery clamping and external renal hypothermia cause any detrimental effect on the remaining renal parenchyma after nephron-sparing surgery with the use of (99m)Tc-DMSA-SPECT.
Methods: Twenty-eight patients with a unilateral renal mass but a normal contralateral kidney underwent nephron-sparing surgery. Serum biochemistry, 24-hour urinary creatinine clearance and absolute uptakes of the injected dose (%ID) of both kidneys as measured by renal (99m)Tc-DMSA-SPECT were compared preoperatively and in the 3rd postoperative month. (99m)Tc-DMSA uptakes in the contralateral kidney were used as controls.
Results: The average tumor size and mean renal artery clamping time were 37.4 +/- 11.3 (range 25-68) mm and 53.7 +/- 13 (range 38-90) min, respectively. Pre- and postoperative mean absolute uptakes of %ID in the remaining parenchyma of the operated kidneys were 15.13 +/- 3.30 and 14.74 +/- 3.38%, respectively (p = 0.052). In the contralateral kidneys, there was also no significant difference between the two studies (18.82 +/- 6.26 vs. 19.14 +/- 7.19%, respectively; p = 0.546). Likewise, there was no statistically significant difference between pre- and postoperative serum creatinine (p = 0.179) and creatinine clearance values (p = 0.108).
Conclusion: Renal artery clamping and external cooling during nephron-sparing surgery have no demonstrable harmful effects on the renal parenchyma as measured by (99m)Tc-DMSA-SPECT analysis.
((c) 2009 S. Karger AG, Basel.)