Renal oxygenation during robot-assisted laparoscopic partial nephrectomy: characterization using laparoscopic digital light processing hyperspectral imaging.

UNLABELLED Abstract Background and Purpose: Digital light processing-based hyperspectral imaging (DLP(®)-HSI) was adapted for use during laparoscopic surgery by coupling the spectral illumination source with a conventional laparoscopic light guide and incorporating a customized digital charge-coupled device camera for image acquisition. The system was used to characterize renal oxygenation during robot-assisted laparoscopic partial nephrectomy (RALPN) in humans. PATIENTS AND METHODS After Institutional Review Board approval, laparoscopic DLP-HSI was performed in consecutive patients undergoing RALPN at our institution. Time trends in relative tissue oxygen saturation (%HbO2) were descriptively analyzed. Associations between %HbO2 and patient age, comorbidities, and estimated glomerular filtration rate (eGFR) were investigated using the Kendall tau test. RESULTS Laparoscopic DLP-HSI was performed in 18 patients between May 2011 and February 2012. Median (interquartile range; IQR) age was 55.9 (49-67.5) years. Of the patients, 10/18 (56%) were men and 12/18 (66.7%) had a history of hypertension, diabetes, and/or tobacco use. Median (IQR) %HbO2 before, during, and after ischemia was 60.8% (57.9-68.2%), 53.6% (46.8-55.1%), and 61.5% (54.9-67.6%), respectively. Baseline %HbO2 was inversely associated with preoperative eGFR (τ=-0.38; P=0.036), and eGFR at most recent follow-up (τ=-0.38; P=0.036). Baseline or ischemic %HbO2 did not correlate with hypertension, diabetes, and/or tobacco history. Younger patients (<56 years) had a lower median baseline %HbO2 (P=0.07) and a higher median preoperative eGFR (P=0.038), than their older counterparts. CONCLUSION The laparoscopic HSI system successfully characterized dynamic changes in renal oxygenation during RALPN. Intraoperative laparoscopic HSI outcomes have the potential to predict postoperative individual kidney function.

[1]  D F DAVIES,et al.  Age changes in glomerular filtration rate, effective renal plasma flow, and tubular excretory capacity in adult males. , 1950, The Journal of clinical investigation.

[2]  A F Goetz,et al.  Imaging Spectrometry for Earth Remote Sensing , 1985, Science.

[3]  P. Kurnik,et al.  Renal and systemic oxygen consumption in patients with normal and abnormal renal function. , 1992, Journal of the American Society of Nephrology : JASN.

[4]  W. Bemelman,et al.  Laparoscopic cholecystectomy using abdominal wall retraction , 1997, Surgical Endoscopy.

[5]  M. Gladwin,et al.  Noninvasive Determination of Spatially Resolved and Time-Resolved Tissue Perfusion in Humans During Nitric Oxide Inhibition and Inhalation by Use of a Visible-Reflectance Hyperspectral Imaging Technique , 2001, Circulation.

[6]  Georg Bartsch,et al.  Robotic-assisted laparoscopic partial nephrectomy: technique and initial clinical experience with DaVinci robotic system. , 2004, Urology.

[7]  F. Jensen.  Red blood cell pH, the Bohr effect, and other oxygenation-linked phenomena in blood O2 and CO2 transport. , 2004, Acta physiologica Scandinavica.

[8]  G. Fried,et al.  Effect of pneumoperitoneum on renal perfusion and function: A systematic review , 2007, Surgical Endoscopy.

[9]  J. Kaouk,et al.  Guideline for management of the clinical T1 renal mass. , 2009, The Journal of urology.

[10]  Rahul P. Naik,et al.  A Prospective Randomized, Controlled Study Comparing Low Pressure Versus High Pressure Pneumoperitoneum During Laparoscopic Cholecystectomy , 2009, Surgical laparoscopy, endoscopy & percutaneous techniques.

[11]  Joshua R. Smith,et al.  First Prize: Characterization of Renal Ischemia Using DLP® Hyperspectral Imaging: A Pilot Study Comparing Artery-Only Occlusion Versus Artery and Vein Occlusion , 2010 .

[12]  S. Bhayani,et al.  Robot-assisted partial nephrectomy: an international experience. , 2010, European urology.

[13]  Jean-Jacques Patard,et al.  EAU guidelines on renal cell carcinoma: the 2010 update. , 2010, European urology.

[14]  J. Cadeddu,et al.  Assessment of renal oxygenation during partial nephrectomy using hyperspectral imaging. , 2010, Journal of Urology.

[15]  Robert P. Francis,et al.  Active DLP hyperspectral illumination: a noninvasive, in vivo, system characterization visualizing tissue oxygenation at near video rates. , 2011, Analytical chemistry.

[16]  Samuel K. Park,et al.  Self-retaining barbed suture for parenchymal repair during minimally invasive partial nephrectomy. , 2011, Journal of endourology.

[17]  B. Jeong,et al.  Adult Urology Oncology: Adrenal/Renal/Upper Tract/Bladder Does Prolonged Warm Ischemia After Partial Nephrectomy Under Pneumoperitoneum Cause Irreversible Damage to the Affected Kidney? , 2022 .

[18]  G. Piccoli,et al.  Long-term functional evaluation of the treated kidney in a prospective series of patients who underwent laparoscopic partial nephrectomy for small renal tumors. , 2012, European urology.