Abstract: PD66-06
Sources of Funding: None

Introduction

Mannitol solution has been an agent utilized to improve kidney circulation and decrease reperfusion injury to attempt to maintain renal function. With the development of partial nephrectomy (PN) as the preferred surgical approach, the use of mannitol was adopted as a way to theoretically prevent damage during the kidney’s ischemic time. After oncologic outcomes, maintenance of renal function is a principal goal. With advancements in minimally invasive techniques, the utilization of mannitol has been called into question. Robotic-assisted laparoscopic partial nephrectomy (RALPN) has been shown to decrease warm ischemia time, which may potentially minimize the benefit of mannitol. To date, no prospective, randomized, controlled trials have investigated the use of mannitol in the robotic procedure. We hypothesize that the intra-operative mannitol use during RALPN provides no statistically significant benefit for post-operative renal function outcomes.

Methods

We conducted a randomized, controlled, double blinded, single surgeon, prospective study to assess renal function after RALPN. Patients were randomized into a control group with intravenous normal saline infusion prior to clamping of the vessels or to an experimental group with an infusion of mannitol. Monitoring of Creatinine (sCr) and estimated glomerular filtration rate (eGFR) were obtained prior to the surgery as well as post operatively at 24 hours, 1 week, and 30 days. A descriptive analysis of the study groups was performed using means, standard deviations, ranges and percentages. Subgroup comparisons examined differences in the percent change of eGFR and sCR post-surgery. Continuous variables were analyzed using the Student’s t-test and categorical variables using Fisher’s Exact Test with a p < 0.05 considered statistically significant.

Results

Patient demographics as well as tumor characteristics were similar between the two groups other than patient BMI. Preoperative sCR and eGFR showed no statistical differences between the groups and evaluation of percent change in sCR and eGFR after surgery did not indicate a significant difference between the groups after RALPN (p>0.05).

Conclusions

After prospective analysis of the change in post-operative renal function of randomized groups following RALPN, we determined no statistically significance. Further evaluation with increased numbers, long term follow-up, and expansion to multiple institutions may further support this conclusion. Based on this evaluation, infusion of mannitol does not provide significant improvement of maintenance of renal functions after RALPN.

Funding

None