Strategies to Extend Warm Ischemia Time During Laparoscopic Partial Nephrectomy-Part II

AUTHORS

Thambi Dorai 1 , * , Catherine Michels 2 , David S Goldfarb 3 , Michael Grasso 3

1 Department of Urology, Saint Vincent Catholic Medical Centers, tdorai@svcmcny.org, USA

2 Department of Urology, New York Medical College, New York, U.S

3 Nephrology Section, Veterans Affairs Medical Center, U.S

How to Cite: Dorai T, Michels C, Goldfarb D, Grasso M. Strategies to Extend Warm Ischemia Time During Laparoscopic Partial Nephrectomy-Part II, Nephro-Urol Mon. Online ahead of Print ; 2(1):151-171.

ARTICLE INFORMATION

Nephro-Urology Monthly: 2 (1); 151-171
Article Type: Review Article
Received: April 25, 2009
Accepted: June 2, 2009

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Abstract

In this part of the review, particular attention is drawn towards the mechanisms by which one can pre-condition the kidneys pre-operatively by using several strategies that are nutritional, biochemical, pharmacological and environmental in nature.  In addition, ideas and hypotheses are put forward that are relevant to modulating the anoxic and autophagic response to ischemic damage during laparoscopic partial nephrectomy, particularly with respect to reducing the endoplasmic reticulum stress. Finally, the current trends in research involving the role of stem cells, renal hibernation and the role of the innate immune response are highlighted with the aim of exploiting these mechanisms to achieve reduced kidney damage during ischemia. Finally, the common thread behind all these approaches, namely empowering the renal mitochondria during ischemia is emphasized.

Keywords

laparoscopic partial nephrectomy, ischemia, hypoxia, anoxia, mitochondrial dysfunction, reactive oxygen species.

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