Robotic and laparoscopic urologic surgery ischemic preconditioning

Abstract

Laparoscopic and robotic assisted surgeries have evolved from a limited surgical procedure to a major surgical technique during the last three decades. The indications increased incrementally. Despite its several advantages, it has some surgery and pneumoperitoneum related adverse effects and hemodynamic complications. One of them is the ischemia reperfusion injury (IRI) of the abdominal organs that can be developed secondary to pneumoperitoneum. IRI is also a risk factor for acute kidney injury in partial nephrectomy surgeries even performed via open, or laparoscopic/robotic assisted. To reduce or avoid the IRI related complications during laparoscopy and robotics, several alternative approaches were suggested including ischemic preconditioning (IPC). IPC is a phenomenon that promotes tissue tolerance to ischemia. Since it was first introduced, several studies evaluating its protective effects or mechanism of action have been published. Majority of them demonstrated its potent beneficial effects against IRI. Despite these favorable results, IPC has not yet been used in clinical settings routinely. The unknown parts of the exact mechanisms, the lack of standard protocols for its use such as the duration of clamping, the number of clamping cycles, using an early window or a late window, using local IP or remote IP, and the all remaining uncertainly about these aspects of the process might lead clinicians to be hesitant about its clinical use. In this study we discussed what we have in our hands regarding the effects of IRI and protective mechanisms of IPC, animal studies and clinical evidence of IPC, remote and local IPC, laparoscopy/robotics induced IRI, and role of laparoscopic/robotic IPC.

Keywords

Robotics / laparoscopy / urology / ischemic preconditioning

References

[1] Murry CE,Reimer KA.Preconditioning with ischaemia: a delay of lethal cell injury in ischemic myocardium..Circulation1986;74:1124-36

[2] Bonventre JV.Cellular pathophysiology of ischemic acute kidney injury..J Clin Invest2011;121:4210-21 PMCID:PMC3204829

[3] Eltzschig HK.Ischemia and reperfusion from mechanism to translation..Nat Med2011;17:1391-401 PMCID:PMC3886192

[4] Ii M,Iwakura A,Eaton E,Losordo DW.Endothelial progenitor cells are rapidly recruited to myocardium and mediate protective effect of ischemic preconditioning via "imported" nitric oxide synthase activity..Circulation2005;111:1114-20

[5] O'Malley C.Physiologic changes during laparoscopy..Anesthesiol Clin North Am2001;19:1-19

[6] Schäfer M.Effects of laparoscopy on intra-abdominal blood flow..Surgery2001;129:385-9

[7] Schachtrupp A,Hoer J,Lawong AG.A 24-h pneumoperitoneum leads to multiple organ impairment in a porcine model..J Surg Res2002;106:37-45

[8] Campbell SC,Belldegrun A,Chow GK,Faraday MM,Leveillee RJ,Russo P.Guideline for management of the clinical T1 renal mass..J Urol2009;182:1271-9

[9] Petrasz P,Sikorski A.Impact of ''nonclamping technique'' on intra- and postoperative course after laparoscopic partial nephrectomy..Wideochir Inne Tech Maloinwazyjne2012;7:275-9 PMCID:PMC3557739

[10] Abe T,Harabayashi T,Maruyama S,Matsumoto R,Nonomura K.Renal hypothermia with ice slush in laparoscopic partial nephrectomy: the outcome of renal function..J Endourol2012;26:1483-8

[11] Shao P,Yin C,Ju X,Lv Q,Xu Z.Laparoscopic partial nephrectomy with segmental renal artery clamping: technique and clinical outcomes..Eur Urol2011;59:849-55

[12] Gill IS,Aron M,Ukimura O,Campese V,Desai MM.''Zero ischemia'' partial nephrectomy: novel laparoscopic and robotic technique..Eur Urol2011;59:128-34

[13] Huang J,Dong B,Zhang J,Liu D.Effect of remote ischaemic preconditioning on renal protection in patients undergoing laparoscopic partial nephrectomy: a 'blinded' randomised controlled trial..BJU Int2013;112:74-80

[14] Zhao ZQ,Halkos ME,Wang NP,Vinten-Johansen J.Inhibition of myocardial injury by ischemic postconditioning during reperfusion: Comparison with ischemic preconditioning..Am J Physiol Heart Circ Physiol2003;285:H579-88

[15] Fan LH,Cao ZQ,Liu L.Effect of ischemia preconditioning on renal ischemia/reperfusion injury in rats..Int Braz J Urol2012;38:842-54

[16] Wever KE,Rovers M,Rongen GA,Ritskes-Hoitinga M,Warlé M.Ischemic preconditioning in the animal kidney, a systematic review and meta-analysis..PLoS One2012;7:e32296 PMCID:PMC3289650

[17] Mahfoudh-Boussaid A,Hadj-Ayed K,Saidane-Mosbahi D,Ben Abdennebi H.Ischemic preconditioning reduces endoplasmic reticulum stress and upregulates hypoxia inducible factor-1α in ischemic kidney: the role of nitric oxide..J Biomed Sci2012;19:7 PMCID:PMC3398272

[18] Kim J,Jang HS,Park KM.Protective role of cytosolic NADP(+)-dependent isocitrate dehydrogenase, IDH1, in ischemic pre-conditioned kidney in mice..Free Radic Res2011;45:759-66

[19] Chen X,Wan X,Chen Y.Ischemic preconditioning attenuates renal schemia-reperfusion injury by inhibiting activation of IKKbeta and infl ammatory response..Am J Nephrol2009;30:287-94

[20] Koo DD,West NE,Penington AJ,Morris PJ.Endothelial cell protection against ischemia/reperfusion injury by lecithinized superoxide dismutase..Kidney Int2001;60:786-96

[21] Singbartl K.Protection from ischemia-reperfusion induced severe acute renal failure by blocking E-selectin..Crit Care Med2000;28:2507-14

[22] Xue J,Li X,Jia R.Protective effects of ischemic preconditioning-mediated homing of endothelial progenitor cells on renal acute ischemia and reperfusion injury in male rats..Ann Transplant2017;22:66-74

[23] Hernandez DJ,Miles-Thomas J,Saha S,Racusen LC.Can ischemic preconditioning ameliorate renal ischemia-reperfusion injury in a single-kidney porcine model?.J Endourol2008;22:2531-6

[24] Yoon YE,Choi KH,Yang SC.Preconditioning strategies for kidney ischemia reperfusion injury: implications of the "time-window" in remote ischemic preconditioning..PLoS One2015;10:e0124130 PMCID:PMC4400007

[25] Ambros JT,Borau OG.Ischemic preconditioning in solid organ transplantation: from experimental to clinics..Transpl Int2007;20:219-29

[26] Pasupathy S.Ischaemic preconditioning protects against ischaemia/reperfusion injury: emerging concepts..Eur J Vasc Endovasc Surg2005;29:106-15

[27] Orvieto MA,Mendiola FP,Lucioni A,Gofrit ON.Ischemia preconditioning does not confer resilience to warm ischemia in a solitary porcine kidney model..Urology2007;69:984-7

[28] Yamashita N,Taniguchi N,Hori M.A "second window of protection" occurs 24 h after ischemic preconditioning in the rat heart..J Mol Cell Cardiol1998;30:1181-9

[29] Kosieradzki M,Southard JH.Is ischemic preconditioning of the kidney clinically relevant?.Surgery2003;133:81-90

[30] Heusch G,Przyklenk K,Yellon D.Remote ischemic conditioning..J Am Coll Cardiol2015;65:177-95 PMCID:PMC4297315

[31] Kharbanda RK,White PA,Schmidt MR,Vogel M,Redington AN.Transient limb ischemia induces remote ischemic preconditioning in vivo..Circulation2002;106:2881-3

[32] Ali ZA,Lim E,Nouraei SA,Boyle JR,Kharbanda RK,Gaunt ME.Remote ischemic preconditioning reduces myocardial and renal injury after elective abdominal aortic aneurysm repair: a randomized controlled trial..Circulation2007;116:I98-105

[33] Bedir S,Antonelli J,Gahan JC.Ineffectiveness of remote ischemic renal preconditioning in a porcine solitary-kidney model..J Endourol2015;29:590-4

[34] Galizia G,Lieto E,Pelosio L,Ferrara A.Hemodynamic and pulmonary changes during open, carbon dioxide pneumoperitoneum, and abdominal wall-lifting cholecystectomy. A prospective, randomized study..Surg Endosc2001;15:477-83

[35] Wittgen CM,Fitzgerald SD,Dahms TE.Analysis of the hemodynamic and ventilatory effects of laparoscopic cholecystectomy..Arch Surg1991;126:997-1000

[36] Eleftheriadis E,Papanotas K,Sarris K.Gut ischaemia, oxidative stress, and bacterial translocation in elevated abdominal pressure in rats..World J Surg1996;20:11-6

[37] Glantzounis GK,Tambaki AP,Manataki AD,Tsimoyiannis EC.Laparoscopic surgery-induced changes in oxidative stress markers in human plasma..Surg Endosc2001;15:1315-9

[38] Akbulut G,Polat C,Aktepe F,Gokçe C.Changes in tissue oxidative stress markers in an experimental model of laparoscopic donor nephrectomy..Transplantation2002;74:1768-72

[39] Giraudo G,Caccetta M.Gasless laparoscopy could avoid alterations in hepatic function..Surg Endosc2001;15:741-6

[40] Samel ST,Mueller A,Becker H.A new abdominal cavity chamber to study the impact of increased intra-abdominal pressure on microcirculation of gut mucosa by using video microscopy in rats..Crit Care Med2002;30:1854-8

[41] Richter S,Hildebrandt U,Vollmar B.Loss of physiologic hepatic blood flow (''hepatic arterial buffer response'') during CO2-pneumoperitoneum in the rat..Anesth Analg2001;93:872-7

[42] Yilmaz S,Kahraman A,Arikan Y,Gîkáe O.The comparison of the oxidative stress effects of different gases and intra-abdominal pressures in an experimental rat model..J Laparoendosc Adv Surg Tech A2004;14:165-8

[43] Polat C,Serteser M,Kahraman A.The effect of different intra-abdominal pressures on lipid peroxidation and protein oxidation status during laparoscopic cholecystectomy..Surg Endosc2003;17:1719-22

[44] Biler A,Sendag F,Akdemir A,Uyanikgil Y,Sezer E.The effects of different intraabdominal pressure protocols in laparoscopic procedures on oxidative stress markers and morphology in rat ovaries..Adv Clin Exp Med2014;23:885-92

[45] McCafferty K,Yaqoob MM.Ischaemic conditioning strategies for the nephrologist: a promise lost in translation?.Nephrol Dial Transplant2014;29:1827-40

[46] Yilmaz S,Polat C,Tokyol C,Gokce O.Ischaemic preconditioning decreases laparoscopyinduced oxidative stress in small intestine..Hepatogastroenterology2003;50:979-82

[47] Yilmaz S,Tokyol C,Akbulut G,Polat C,Gokce O.Can preconditioning reduce laparoscopy-induced tissue injury?.Surg Endosc2003;17:819-24

[48] Imamoglu M,Unsal MA.The effects of increased intraabdominal pressure on testicular blood flow, oxidative stres markers, and morphology..J Pediatr Surg2006;41:1118-24

[49] Arioz DT,Tokyol C,Yilmaz S,Saylan A,Tekin A.What should be the ideal time for ischemic preconditioning in a laparoscopic rat model?.J Laparoendosc Adv Surg Tech A2009;19:141-7

[50] Yellon DM.The preconditioning phenomenon: a tool for the scientist or a clinical reality?.Circ Res2000;87:543-50