PURPOSE: To describe the first report of a technique for performing completely intracorporeal renal autotransplantation with both the donor nephrectomy and transplantation performed minimally-invasively without ever extracting the kidney.
MATERIALS AND METHODS: We developed a technique for completely intracorporeal robotic renal autotransplantation and demonstrated the feasibility of this novel procedure. This includes a method for intracorporeal transarterial hypothermic renal perfusion using a perfusion catheter through a laparoscopic port. The procedure was successfully applied in a 56-year-old man with extensive left ureteral loss after failed ureteroscopy for ureterolithiasis.
RESULTS: Robotic donor nephrectomy was performed with warm ischemia time of 2.3 minutes after which cold ischemia was achieved with intracorporeal hypothermic renal perfusion for a duration of 95.5 minutes. Vascular anastomoses and ureteroureterostomy in the ipsilateral pelvis were completed after donor nephrectomy with a total overall surgeon console time of 334 minutes. Venous and arterial anastomosis times were 17.3 and 21.3 minutes, respectively. Estimated blood loss was less than 50mL. There were no complications, and the patient was discharged home on the first postoperative day after normal Doppler transplant renal ultrasound. Renal scan at 6-weeks, intravenous urogram at 8-weeks, and CT urography at 5-months postoperatively revealed normal function and a successful ureteral reconstruction.
CONCLUSION: We demonstrated the feasibility of a technique for completely intracorporeal robotic renal autotransplantation. This operation may be considered for select patients in the hands of experienced robotic surgeons, but further refinement is required as this novel procedure is cautiously reproduced and adopted by others.
Written by:
Gordon ZN, Angell J, Abaza R. Are you the author?
Department of Urology, The Ohio State University Wexner Medical Center & James Cancer Hospital, Columbus, OH.
Reference: J Urol. 2014 Jun 21. pii: S0022-5347(14)03822-1.
doi: 10.1016/j.juro.2014.02.2589
PubMed Abstract
PMID: 24960467
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