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Zor et al. Mini-invasive Surg 2018;2:12 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2017.34

Review Open Access

Robotic and laparoscopic urologic surgery ischemic
preconditioning

Murat Zor , Kubra Ozgok Kangal
2
1
1 Department of Urology, Gulhane Research and Training Hospital, Ankara 06010, Turkey.
2 Department of Undersea and Hyperbaric Medicine, Gulhane Research and Training Hospital, Ankara 06010, Turkey.
Correspondence to: Dr. Murat Zor, Department of Urology, Gulhane Research and Training Hospital, Ankara 06010, Turkey.
E-mail: murat804@yahoo.com

How to cite this article: Zor M, Kangal KO. Robotic and laparoscopic urologic surgery ischemic preconditioning. Mini-invasive Surg
2018;2:12. http://dx.doi.org/10.20517/2574-1225.2017.34

Received: 3 Aug 2017 First Decision: 6 Feb 2018 Revised: 24 Feb 2018 Accepted: 8 May 2018 Published: 15 May 2018
Science Editors: Yasar Ozgok, Charles F. Bellows Copy Editor: Jun-Yao Li Production Editor: Cai-Hong Wang

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

INTRODUCTION
Laparoscopic and subsequently developed robotic assisted surgeries have evolved from a limited surgical
procedure to a major surgical technique during the last three decades. The indications were increased

© The Author(s) 2018. Open Access This article is licensed under a Creative Commons Attribution 4.0
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