The hemodynamic effects of CO2-induced pressure on the kidney in an isolated perfused rat kidney model.
ABSTRACT Variable mechanisms were suggested to mediate the changes in renal hemodynamics during pneumoperitoneum. To assess whether it can be pressure dependent only, we conduct a study in an isolated, pressurized, and perfused organ model.
Seventy Wistar rat kidneys were perfused with oxygenated, 3% albumin-contained Krebs-Henseleit solution. Experiments took place within Plexiglass chamber that provided conditions for perfusion of organs, humidity, and maintenance of intracameral CO2 pressures [0 (control), 3, 5, 8, 12, 15, and 18 mm Hg]. All kidneys (10/group) were perfused for 60 minutes. One-half of the groups were perfused for an additional 30 minutes, during which the perfusion pressures were reduced to 0 mm Hg. pH of the perfusate was measured as well.
The perfusion pressure increased and the kidney flow decreased slightly, in proportion with the intrachamber pressure. Urine output decreased to a minimum of 40% in >or=8 mm Hg pressure conditions, compared with the control group. The pH values were below normal, during experimental pneumoperitoneum.
Pneumoperitoneal conditions are a direct cause of changes in renal urinary output. The increase in pCO2 pressure and consequently low intraorgan pH may contribute to a mild transient renal damage during pneumoperitoneum.
- SourceAvailable from: Iraj Jafari Anarkooli[Show abstract] [Hide abstract]
ABSTRACT: This study aimed to investigate the effect of different pressures of CO2 on expression of P33 gene and apoptosis in liver and spleen cells during CO2 pneumoperitoneum. In this study, 30 male Sprague-Dawley rats, weighing approximately 280-340 grams were procured from Tehran Pasteur Institute’s animal house, and randomly divided into 3 equal groups of 10 each. Groups 1 and 2 received 10 and 20 mmHg respectively, and group 3 was the control group. CO2 was insufflated into abdominal cavity of rats in groups 1 and 2 for one hour using a cannula, and then, perfusion was performed for half an hour. In group 3, cannula was placed into abdominal cavity without releasing any gas. The rats were sacrificed afterwards, and their livers and spleens were removed after laparotomy to investigate expression of gene P33 and apoptosis using RT-PCR and TUNEL techniques. The TUNEL technique showed a significant increase in apoptosis in liver and spleen cells of rats that received 20 mmHg compared to rats that received 10 mmHg and control group (P<0.0001) and (P<0.006).respectively. Furthermore, RT-PCR revealed a significant decrease in P33 gene mRNA in liver and spleen cells in 20 mmHg group compared to other two groups (P<0.001). Too high a pressure or too long a duration of CO2 gas may cause release of cytokines and free-radicals from cells of these organs, which can lead to transient or serious dysfunction.Jokull 01/2015; 65(2):48-65. · 1.07 Impact Factor
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ABSTRACT: We report a new method of tumor exposure through a minilaparotomy window and cold ischemia using a LapSac® during partial nephrectomy by video-assisted minilaparotomy surgery (VAMS).Korean journal of urology 01/2009; 50(8). DOI:10.4111/kju.2009.50.8.774
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ABSTRACT: Aiming the principles of open partial nephrectomy, warm ischemia time is the limiting factor especially in case of central or complex tumors in laparoscopy. We demonstrate a novel solely laparoscopic technique for in situ cold perfusion of kidneys with direct catheterization of the renal artery to increase the tolerance of renal parenchyma for ischemia. In two patients with hilus compromising tumors, renal artery was clamped; a small incision in the artery was used to place a 5Fr centrally open angiographic balloon catheter and blocked with 1 ml NaCl. The kidney was perfused with 4°C Ringer solution. After tumor excision, the kidney was subsequently reconstructed by mattress bolster sutures and fibrin glue. The arterial incision was closed by a 4/0 Prolene suture. Both patients had an uneventful follow-up without neither intraoperative nor postoperative complications. No intraoperative body temperature drop occurred. Cold ischemia time was 66 (men, 65a) and 60 min (women, 43a), respectively. Hemoglobin drop was 4.1 and 1.9 g/dl; no transfusion was necessary. Preoperative and postoperative creatinine levels were 0.90 and 0.76 mg/dl, and 1.3 and 0.9 mg/dl, respectively. Patients were discharged on day 12 and day 8. Histology revealed clear cell RCC (pT1b pNx pMx G2 R0) in the first patient and oncocytoma in the second patient. Postoperative CT angiograpy demonstrated no sign of arterial insufficiency. Intraarterial renal cooling could expand the ischemia time and therefore the indication of laparoscopic partial nephrectomy in complex exposition. Furthermore, the identification of tumor borders and injured vessels is facilitated by the outflow of the cooling solution. Further investigations into this promising method could proof its feasibility in everyday clinical routine.World Journal of Urology 10/2010; 29(3):337-42. DOI:10.1007/s00345-010-0597-4 · 3.42 Impact Factor