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

Thambi Dorai; Catherine Michels; David Goldfarb; Michael Grasso

Nephro-Urology Monthly

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

Author(s):

Thambi Dorai^1,*,

Catherine Michels²,

David S Goldfarb³,

Michael Grasso³

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

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

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

Nephro-Urology Monthly:Vol. 2, issue 1; 151-171

Article type:Review Article

Received:Apr 25, 2009

Accepted:Jun 02, 2009

How to Cite:Thambi DoraiCatherine MichelsDavid S GoldfarbMichael GrassoStrategies to Extend Warm Ischemia Time During Laparoscopic Partial Nephrectomy-Part II.Nephro-Urol Mon.2(1):151-171.

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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