935 JOURNAL OF ENDOUROLOGY Volume 17, Number 10, December 2003 © Mary Ann Liebert, Inc. Effect of Retroperitoneoscopic Donor Nephrectomy on Tissue Oxidative Stress Markers in Rabbit Pneumoretroperitoneum Model CEM GULER, M.D., 1 MURAT DEMIRBAS, M.D., 1 MURAT SAMLI, M.D., 1 TULAY KOKEN, M.D., 2 AHMET KAHRAMAN, M.D., 2 and CETIN DINCEL, M.D. 1 ABSTRACT Background and Purpose: Laparoscopic donor nephrectomy causes increased renal oxidative stress. There are no data about the effects of the retroperitoneoscopic route. The aim of our study was to evaluate the oxida- tive stress occurring in renal tissues during retroperitoneoscopic donor nephrectomy in a rabbit model. Materials and Methods : Eighteen adult rabbits were randomized to three groups, each consisting of six rab- bits. Group I (control) underwent 50-mL balloon dissection of the left retroperitoneal space without CO 2 in- sufflation. Group II (pneumoretroperitoneum) received a 3-hour CO 2 insufflation at a pressure of 10 mm Hg in the retroperitoneal space after balloon dissection. Group III (pneumoretroperitoneum with warm isch- emia), in addition to the procedure applied in Group II, underwent left renal artery clamping for 3 minutes and reperfusion for the next 5 minutes. Bilateral nephrectomy was performed in all animals for analysis of oxidative stress markers. Concentrations of malonyldialdehyde (MDA), protein carbonyl, and reduced glu- tathione (GSH) were measured in renal tissue samples. Results: The MDA and protein carbonyl content were increased both in the donor (P 5 0.004 and P 5 0.004, respectively) and in the remaining kidneys (P 5 0.009 and P 5 0.028, respectively) in Group II compared with Group I. There were no statistically significant increases in oxidative stress markers between Group II and Group III in donor kidneys. However, there were statistically significant decreases in MDA in the remaining kidneys in Group III compared with Group II (P 5 0.009). Conclusion: Pneumoretroperitoneum causes increased oxidative stress in both donor and remaining kid- neys. Short-term warm ischemia and reperfusion do not exert an additive effect on pneumoretroperitoneum- associated oxidative stress in donor kidneys. INTRODUCTION T HE RETROPERITONEUM IS DISSIMILAR to the peri- toneal cavity because it is a possible, but not a true, space. 1 After Gaur described an atraumatic retroperitoneal balloon dilation technique, 2 retroperitoneoscopy became a usable ap- proach to treat urologic pathologic findings. Retroperito- neoscopy has been used for several renal procedures, such as simple nephrectomy,radical nephrectomy,and even live-donor nephrectomy. 1 Following the first successful laparoscopic nephrectomy, re- ported by Clayman and colleagues in 1991, 3 the feasibility of laparoscopic donor nephrectomy (LDN) was established in a porcine model by Gill and associates in 1994. 4 Ratner et al 5 performed the first human LDN in 1995. Although a purely retroperitoneal route through a flank incision is traditionally used for open donor nephrectomy, there have been only a few efforts to apply this approach during minimally invasive endo- scopic urologic surgery. 6,7 Insufflation of CO 2 during laparoscopic procedures can af- fect several homeostatic systems, causing alterations in cardio- vascular,pulmonary,and renalphysiology.It is likely that these effects also occur when the retroperitoneal route is used. 8 In our previous paper, we showed transient deleterious renal ef- Departments of 1 Urology and 2 Biochemistry, The Faculty of Medicine, Afyon Kocatepe University, Afyon, Turkey.