Laparoscopic partial nephrectomy with intra-arterial cold perfusion. What can go wrong?

Introduction. In kidney masses of a high nephrometric index, a variant of renal ischemia is mostly needed, and to increase the time of compression of the renal artery, the cold renal ischemia may be relevant. Advantages of intra-arterial cold perfusion (IACP) are: good visualization and uniform cooling of the entire thickness of the renal parenchyma. This approach is not without its own set of challenges and potential complications during and after surgery. Purpose: to describe complications during kidney resection under IACP and options for their resolution with the practical recommendations based on literature data and clinical cases from our center. Material and Methods. The study included 14 patients with kidney masses of a high nephrometric index (RENAL 10 or more), who underwent kidney resections as an experimental technique under IACP from 2021 to 2024 at P.A. Hertzen Moscow Cancer Research Institute. Results. We identified both intra- and postoperative complications in 6 cases: perforation of the renal artery (n=1), brachial artery thrombosis (n=1), thrombosis of the renal artery (n=1), air embolism of segmental branches of the renal artery (n=2), urine leakage (n=1). Conclusion. The IACP-associated intraoperative complications in our cohort diminished over time as familiarity with the technique improved. The IACP is workable, efficient, and holds promise, indicating its appropriateness for large, well-equipped centers. In patients with just one functioning kidney and high nephrometric index masses needing prolonged ischemia during removal, this technique could become a lifesaving option as expertise grows.