"ICE" is key to new kidney-sparing cancer surgery

A surgical technique known as intracorporeal cooling and extraction (ICE) may reduce the need for conventional open surgery in patients with kidney cancer.

Many people diagnosed with kidney cancer have the entire organ removed—usually through an open approach that requires a large incision and, often, removal of a rib—despite the fact that minimally invasive approaches, such as robotic surgery, are available and may lead to fewer complications, explained study coauthor Craig G. Rogers, MD, director of Renal Surgery at the Henry Ford Hospital's Vattikuti Urology Institute in Detroit, Michigan, in a statement issued by the Henry Ford Health System.

“In order to safely perform a partial nephrectomy, surgeons often have to clamp off the blood supply to the kidney,” pointed out Rogers. “But once the blood supply is cut off, there's only about 30 minutes before the kidney can experience irreversible damage. Time is a barrier for many surgeons to offer the partial nephrectomy procedure to their patients.”

The ICE modification helps overcome those obstacles, reported Rogers and colleagues in European Urology. The team applied the technique to seven patients with kidney cancer who were undergoing robotic partial nephrectomy. A special device called a Gelpoint trocar was used to make easier the task of passing objects into and out of the abdomen through small incisions during minimally invasive surgery. Ice slush was then delivered to the kidney through a modified syringe inserted into the gel point. Therefore, when the blood supply to the kidney was clamped, the organ was packed on ice, just as it would have been during open surgery.

“Once the tumor is removed, instead of setting it aside in the body so you can sew up the kidney, we can remove the tumor as soon as it's excised through the gel point, look at it, and decide if we're happy with what's been removed,” said Rogers. “If there's any doubt, I can go right back in and cut more out.”

In the patients studied, intraoperative assessment of the excised tumor showed adequate gross margins in all cases, and final pathology confirmed negative surgical margins. Renal parenchymal temperatures of less than 16°C were achieved within 7 minutes of cold ischemia, and core body temperature did not drop by more than 0.5°C during any procedures.

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