Laparoscopic renal parenchymal hypothermia with novel ice-slush deployment mechanism.

ABSTRACT

OBJECTIVES: To report the development of a novel, simple-to-use method for laparoscopic deployment of fine-quality saline ice slush by way of a 10-mm end-effector for laparoscopic parenchymal hypothermia. METHODS: A mechanism for making fine ice slush was created, and a 10-mm laparoscopic end-effector was designed and constructed for deployment of the ice slush. The novel ice slush deployment system was tested in a porcine model and compared with that of standard open ice slush cooling. After atraumatic hilar clamping, the cortical and medullary temperatures in the upper, middle, and lower poles were measured with thermocouples. RESULTS: Six pigs were evaluated in each group. In all cases, the kidneys were successfully cooled to our goal temperature of 15 degrees to 25 degrees C within 10 minutes and were maintained at the target temperature for 1 hour. The core body temperature for the slush group was decreased by 3 degrees C but did not change in the open group. The renal temperatures quickly returned to normal on unclamping of the renal hilum. One pig in the open group died of acidosis and another in the same group experienced thrombosis of the renal artery. No complications occurred in the laparoscopic group. CONCLUSIONS: We describe a novel, simple-to-use mechanism for producing and delivering fine ice slush in a laparoscopic setting. The technique achieves optimal parenchymal hypothermia expeditiously.