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Demirelli B, Barutcu Atas D, Dinckan A, Baltacıoglu F, Koc M. A case report with literature review: long-term follow-up of kidney autotransplantation in fibromuscular dysplasia. J Nephrol 2024:10.1007/s40620-024-02105-4. [PMID: 39414714 DOI: 10.1007/s40620-024-02105-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2024] [Accepted: 09/01/2024] [Indexed: 10/18/2024]
Abstract
Fibromuscular dysplasia is a rare, idiopathic, systemic, non-inflammatory, and non-atherosclerotic vascular disease that primarily affects young women. It often presents as renal artery stenosis. Fibromuscular dysplasia can induce tissue damage in the post-stenotic kidney. Treatment options include antihypertensive therapy, surgical revascularization, and transluminal angioplasty with stent implantation. However, kidney autotransplantation is an alternative when these treatments are not feasible. This study presents a case report of a 22-year-old woman with fibromuscular dysplasia, highlighting the long-term success of kidney autotransplantation and reviewing the related literature. A multidisciplinary approach was employed in the treatment of this patient presenting with intermittent headaches, hypertension, and acute kidney disease, and who was diagnosed with fibromuscular dysplasia. She underwent left aorta-renal bypass and right autotransplantation. Following the procedure, her serum creatinine level decreased from 2.74 to 1.1 mg/dL, with an eight-year follow-up confirming the favorable outcome. Renal artery stenosis is a significant contributor to secondary hypertension, with fibromuscular dysplasia being a rare cause. While medical and interventional treatments are usually effective, complex cases may necessitate alternative approaches. Kidney autotransplantation, albeit uncommon, is an effective option for patients who are unresponsive to conventional therapies. This case demonstrates the successful management of fibromuscular dysplasia-associated renovascular hypertension via kidney autotransplantation, resulting in controlled blood pressure and preserved kidney function. In conclusion, kidney autotransplantation represents a valuable therapeutic option for severe renal artery stenosis caused by fibromuscular dysplasia, particularly when percutaneous procedures are impractical.
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Affiliation(s)
- Bulent Demirelli
- Department of Internal Medicine, Division of Nephrology, Marmara University, School of Medicine, Pendik Research and Education Hospital, Fevzi Cakmak Mah. Mimar Sinan Cd. N:41, Pendik, 34854, Istanbul, Turkey
| | - Dilek Barutcu Atas
- Department of Internal Medicine, Division of Nephrology, Marmara University, School of Medicine, Pendik Research and Education Hospital, Fevzi Cakmak Mah. Mimar Sinan Cd. N:41, Pendik, 34854, Istanbul, Turkey
| | - Ayhan Dinckan
- Department of Surgery, Istinye University, Bahcesehir Liv Hospital, 34517, Istanbul, Turkey
| | - Feyyaz Baltacıoglu
- Department of Radiology, Marmara University, School of Medicine, Pendik Research and Education Hospital, 34854, Istanbul, Turkey
| | - Mehmet Koc
- Department of Internal Medicine, Division of Nephrology, Marmara University, School of Medicine, Pendik Research and Education Hospital, Fevzi Cakmak Mah. Mimar Sinan Cd. N:41, Pendik, 34854, Istanbul, Turkey.
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Tchilikidi KY. Ex vivo liver resection and auto-transplantation and special systemic therapy in perihilar cholangiocarcinoma treatment. World J Gastrointest Surg 2024; 16:635-640. [PMID: 38577079 PMCID: PMC10989340 DOI: 10.4240/wjgs.v16.i3.635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/26/2023] [Accepted: 02/18/2024] [Indexed: 03/22/2024] Open
Abstract
This editorial contains comments on the article "Systematic sequential therapy for ex vivo liver resection and autotransplantation: A case report and review of literature" in the recent issue of World Journal of Gastrointestinal Surgery. It points out the actuality and importance of the article and focuses primarily on the role and place of ex vivo liver resection and autotransplantation (ELRAT) and systemic therapy, underlying molecular mechanisms for targeted therapy in perihilar cholangiocarcinoma (pCCA) management. pCCA is a tough malignancy with a high proportion of advanced disease at the time of diagnosis. The only curative option is radical surgery. Surgical excision and reconstruction become extremely complicated and not always could be performed even in localized disease. On the other hand, ELRAT takes its place among surgical options for carefully selected pCCA patients. In advanced disease, systemic therapy becomes a viable option to prolong survival. This editorial describes current possibilities in chemotherapy and reveals underlying mechanisms and projections in targeted therapy with kinase inhibitors and immunotherapy in both palliative and adjuvant settings. Fibroblast grow factor and fibroblast grow factor receptor, human epidermal growth factor receptor 2, isocitrate dehydrogenase, and protein kinase cAMP activated catalytic subunit alpha (PRKACA) and beta (PRKACB) pathways have been actively investigated in CCA in last years. Several agents were introduced and approved by the Food and Drug Administration. They all demonstrated meaningful activity in CCA patients with no global change in outcomes. That is why every successfully treated patient counts, especially those with advanced disease. In conclusion, pCCA is still hard to treat due to late diagnosis and extremely complicated surgical options. ELRAT also brings some hope, but it could be performed in very carefully selected patients. Advanced disease requires systemic anticancer treatment, which is supposed to be individualized according to the genetic and molecular features of cancer cells. Targeted therapy in combination with chemo-immunotherapy could be effective in susceptible patients.
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Affiliation(s)
- Konstantin Y Tchilikidi
- Department of Surgery with Postgraduate Education, Altai State Medical University, Barnaul 656031, Russia
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Han DS, Johnson JP, Schulster ML, Shah O. Indications for and results of renal autotransplantation. Curr Opin Nephrol Hypertens 2023; 32:183-192. [PMID: 36683544 DOI: 10.1097/mnh.0000000000000860] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
PURPOSE OF REVIEW To understand the indications and outcomes of renal autotransplantation, and when to consider this unique procedure for patients. RECENT FINDINGS Renal autotransplantation confers acceptably low rates of graft failure and prevents need for long-term dialysis. Renal autotransplantation remains an important management strategy in very select patients for complex renovascular disease, ureteral stricture disease, ureteral trauma, upper urinary tract urothelial carcinoma, renal cell carcinoma, and Loin-Pain Hematuria Syndrome. With advancements in minimally invasive procedures, the application of renal autotransplantation for refractory stone disease is rare but exists. Robot-assisted laparoscopic renal autotransplantation demonstrates reproducible graft success and complication rates with improved perioperative outcomes (ex. hospital length of stay) - though comparative studies are lacking. Patients would benefit from a multidisciplinary approach from renal transplant surgeons, vascular surgeons, urologists, nephrologists, dieticians, pain management providers, social workers, and psychiatrists. SUMMARY In experienced hands, renal autotransplantation is a reasonable treatment approach for complex and refractory renal vascular disease, Loin-Pain Hematuria Syndrome, ureteral strictures and trauma, upper urinary tract malignancy, and stone disease in highly select patients.
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Affiliation(s)
- David S Han
- Columbia University Irving Medical Center, Department of Urology
| | - Jeffrey P Johnson
- Weill Cornell Medical College, Department of Urology, New York, New York, USA
| | | | - Ojas Shah
- Columbia University Irving Medical Center, Department of Urology
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Damaskos C, Garmpis N, Nikolettos K, Patsouras A, Schizas D, Garmpi A, Georgakopoulou VE, Syllaios A, Dimitroulis D. Comment on renal autotransplantation: A final option to preserve the kidney after an iatrogenic ureteral injury. Arch Ital Urol Androl 2021; 93:497-498. [PMID: 34933543 DOI: 10.4081/aiua.2021.4.497] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Accepted: 07/12/2021] [Indexed: 11/23/2022] Open
Abstract
To the Editor, Autologous Renal Transplantation (ART) since firstly described in 1963 by Hardy, has been used in various cases. There are various reasons for the transplantation such as iatrogenic ureteral damage, chronic kidney pain, unresectable renal tumors or renovascular diseases. Indications concerning the suitable patients for this kind of procedure are gradually increasing. Nevertheless, each case is unique, and the treatment must be personalized [...].
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Affiliation(s)
- Christos Damaskos
- Renal Transplantation Unit, Laiko General Hospital, Athens; N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens.
| | - Nikolaos Garmpis
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens and Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | - Konstantinos Nikolettos
- Obstetric and Gynecologic Clinic, Medical School, Democritus University of Thrace, Alexandroupolis.
| | - Alexandros Patsouras
- N.S. Christeas Laboratory of Experimental Surgery and Surgical Research, Medical School, National and Kapodistrian University of Athens.
| | - Dimitrios Schizas
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | - Anna Garmpi
- First Department of Propedeutic Internal Medicine, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | | | - Athanasios Syllaios
- First Department of Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
| | - Dimitrios Dimitroulis
- Second Department of Propedeutic Surgery, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens.
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Van Praet C, Lambert E, Desender L, Van Parys B, Vanpeteghem C, Decaestecker K. Total Intracorporeal Robot Kidney Autotransplantation: Case Report and Description of Surgical Technique. Front Surg 2020; 7:65. [PMID: 33425979 PMCID: PMC7786393 DOI: 10.3389/fsurg.2020.00065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction and Objectives: Kidney autotransplantation can be performed in patients with complex renal or ureteral pathology not suitable for in situ reconstruction, such as renal vasculature anomalies, patients with proximal or long complex ureteral strictures, or complex oncological cases. Robot-assisted surgery allows for a high-quality vascular and ureteral anastomosis and faster patient recovery. Robot-assisted kidney autotransplantation (RAKAT) is performed in two phases: nephrectomy and pelvic transplantation. In-between, extraction of the kidney allows for vascular reconstruction or kidney modification on the bench and safe cold ischemia can be established. If no bench reconstruction is needed, total intracorporeal RAKAT (tiRAKAT) is feasible. One case report in Europe has been described; however, to our knowledge no surgical video is available. Methods: A 58 year-old woman suffered from right mid- and distal ureteral stenosis following pelvic radiotherapy 10 years prior for cervical cancer. A JJ stent was placed, but she suffered from recurrent urinary tract infections, and ultimately a nephrostomy was placed. Renogram demonstrated 43% relative right kidney function. As her bladder volume was low following radiotherapy, no Boari flap was possible and the patient refused life-long nephrostomy or nephrectomy. Therefore, tiRAKAT was performed using the DaVinci Xi system. Results: We describe our surgical technique including a video. Surgical time (skin-to-skin) was 5 h and 45 min. Warm ischemia time was 4 min, cold ischemia 55 min, and rewarming ischemia 15 min. The abdominal catheter and bladder catheter were removed on the first and second postoperative day, respectively. The JJ stent was removed after 4 weeks. The patient suffered from pulmonary embolism on the second postoperative day, for which therapeutic low molecular weight heparin was started. No further complications occurred during the first 90 postoperative days. After 7 months, overall kidney function remained stable, right kidney function dropped non-significantly from 27 to 25.2 mL/min (−6.7%) on renal scintigraphy. Conclusion: We demonstrated feasibility and, for the first time, a surgical video of tiRAKAT highlighting patient positioning, trocar placement, and intracorporeal cold ischemia technique.
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Affiliation(s)
| | - Edward Lambert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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Zanettini LA, Zanettini LFS, Paulmichl A, Zanettini AC. Solitary kidney and thirteen (13) tumors: Laparoscopic radical nephroureterectomy, bench ex-vivo nephron-sparing surgery and auto-transplantation. Int Braz J Urol 2020; 46:1102-1105. [PMID: 32822142 PMCID: PMC7527098 DOI: 10.1590/s1677-5538.ibju.2019.0443] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2019] [Accepted: 12/16/2019] [Indexed: 11/22/2022] Open
Affiliation(s)
| | | | - Alan Paulmichl
- Serviço de Urologia, Unimed Nordeste, Caxias do Sul, RS, Brasil
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Tonyali S, Haberal HB, Bilen CY, Aki FT. Feasibility of Boari Bladder Flap Procedure in Patients With Heterotrophic Renal Transplant. EXP CLIN TRANSPLANT 2019; 17:599-603. [PMID: 31050619 DOI: 10.6002/ect.2018.0395] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Our goal was to investigate the safety and efficacy of the Boari bladder flap procedure in patients who received either allogeneic or autotransplant of kidneys. MATERIALS AND METHODS We retrospectively reviewed the medical records of all patients with either allogeneic or autotransplant of kidneys who also underwent Boari bladder flap procedures between January 2007 and January 2018. Boari bladder flap was preferred in management of ureteral com-plications after allogeneic renal transplant or it was combined with renal autotransplant when ureteral length was not sufficient to allow ureterovesical anastomosis in patients with ureteral injury. RESULTS Boari bladder flap procedures were performed in 14 patients who had undergone heterotrophic renal transplant. Nine patients had undergone allogeneic renal transplant, and 5 patients had renal auto-transplant. The mean age of patients was 41.7 ± 13.4 years. The 5 patients with renal autotransplant procedures had simultaneous Boari flap procedures due to ureteral avulsion during retrograde ureter-orenoscopic surgery for urolithiasis. For the entire cohort, mean preoperative and postoperative (at month 1) serum creatinine levels were 1.42 ± 0.71 and 1.13 ± 0.43 mg/dL, respectively. At last visit, the mean creatinine level was 1.94 ± 1.88 mg/dL. CONCLUSIONS The Boari bladder flap procedure can be a safe and relevant choice in the management of challenging complications after heterotrophic (either allogeneic or autotransplant) renal transplant, allowing minimally invasive urologic surgery, no need for use of bowel segments, and no potential risk for the contralateral kidney.
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Affiliation(s)
- Senol Tonyali
- From the Department of Urology, Hacettepe University School of Medicine, Ankara, Turkey
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Doumerc N, Beauval JB, Roumiguié M, Roulette P, Laclergerie F, Sallusto F, Soulié M, Gamé X, Biscans C. Total intracorporeal robotic renal auto-transplantation: A new minimally invasive approach to preserve the kidney after major ureteral injuries. Int J Surg Case Rep 2018; 49:176-179. [PMID: 30015216 PMCID: PMC6070672 DOI: 10.1016/j.ijscr.2018.06.017] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Revised: 06/05/2018] [Accepted: 06/14/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Renal auto-transplantation is a suitable option for managing patients with major ureteric injury. Conventional Renal auto-transplantation is however, underutilized because of its invasiveness. Completely intra-corporeal robotic renal auto-transplantation is a suitable option to decrease the morbidity. In this case, we report the first use of total intra-corporeal robotic renal auto-transplantation outside of North America. CASE REPORT A 30-year-old woman presented with an extensive upper left ureter defect, following a high kinetic energy trauma. She underwent 2 median laparotomies, with extensive resection of small intestine, and 1 transverse laparotomy to repair a massive rupture of abdominal muscles. The procedure was performed via a transperitoneal approach, with the assistance of the da Vinci Si robot (Intuitive Surgical Inc. Sunnyvale, CA, USA). The renal auto-transplantation was conducted entirely robotically, in 2 separate stages, using a 4 robotic arm approach. Total operative time was 300 min: 150 min to harvest the kidney including adhesiolysis, 20 min to reposition the patient, and 130 min for the robot assisted kidney transplantation (RAKT). The total ischemia time was 96 min (3 min of warm ischemia, no cold ischemia, 93 min of rewarming time). The estimated blood loss was 150 mL. CONCLUSION To our knowledge, this is the first case successfully performed as a total robotic approach outside of North America.
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Affiliation(s)
- Nicolas Doumerc
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Jean-Baptiste Beauval
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Mathieu Roumiguié
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Pauline Roulette
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Florian Laclergerie
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Federico Sallusto
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Michel Soulié
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Xavier Gamé
- Urology and Renal Transplantation Department, University Hospital of Rangueil, Toulouse, France.
| | - Clément Biscans
- University Hospital of Poitiers, 2 Rue de la Milétrie, 86021 Poitiers, France.
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Janssen MWW, Linxweiler J, Philipps I, Bütow Z, Siemer S, Stöckle M, Ohlmann CH. Kidney autotransplantation after nephrectomy and work bench surgery as an ultimate approach to nephron-sparing surgery. World J Surg Oncol 2018; 16:35. [PMID: 29463251 PMCID: PMC5819675 DOI: 10.1186/s12957-018-1338-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Accepted: 02/07/2018] [Indexed: 12/16/2022] Open
Abstract
Background Kidney autotransplantation (KAT) is the ultimate approach for nephron-sparing surgery. It is a rarely used method in renal tumor surgery today as minimal invasive and open techniques for nephron-sparing surgery improve constantly. In this publication, the complication rate and the long-term functional and oncological outcome at a single center are analyzed. Methods A prospectively constructed database of patients with renal tumors who underwent renal surgery was retrospectively analyzed to identify patients with KAT and describe surgical and oncological outcomes and to obtain long-term follow-up. Data collection included detailed surgical technique, complications (Clavian-Dindo), and hospital stay, as well as functional and oncological outcome and long-term follow-up. Results Between 1976 and 2013, 12 patients (median age 50.5 years) underwent KAT for highly complex renal masses: in five cases for complex renal cell carcinoma (RCC), five cases for complex upper urinary tract carcinoma (UTUC), one case for a renal metastasis, and one case for nephroblastoma. The nephrectomy or nephron-ureterectomy was performed open via a flank or transabdominal. The median surgical time was 360 min (range 270–490 min). Intraoperatively, six cases required blood transfusions (50%). Six patients (50%) developed significant postoperative complications (Clavian-Dindo > 2). In two patients, intermittent hemodialysis for delayed graft function (16.6%) was needed, and in six cases (50%), additional blood transfusions postoperatively were necessary. At discharge from hospital, all patients had functioning grafts. The median hospital stay was 29.5 days (range 18–35). At follow-up (median follow-up of 83.5 ± 40.7 months), six patients had died (50%)—all with functioning grafts (free from hemodialysis). In five cases, recurrence of primary tumor or metastatic disease was recorded. In four cases, the recurrent carcinoma could be resected; in detail, UTUC in three cases and one partial nephrectomy of the autotransplanted kidney was performed. One patient suffered from bone and lung metastasis. Two patients died finally tumor-related. Five patients (41.6%) are presently alive, without evidence of tumor relapse. One patient developed terminal renal failure requiring hemodialysis 105 months after autotransplantation. One additional patient was lost to follow-up; after 69 months, this patient had a functioning kidney and no evidence of disease-recurrence at the last follow-up. A cumulative number of 1424 months without hemodialysis was gained for these 12 patients. In the literature to date, most KAT are performed in benign disease, with minor but frequent complication. Here, we report the largest series of KAT for malignant kidney tumors. The complication rates are similar, compared to the recently reported series for benign indications with an improved graft survival rate. Since KAT requires a complex and challenging surgical approach, it should be performed by experienced kidney transplant surgeons. Conclusion In very complex cases involving renal tumors and multi-morbidity, patients should be counseled well before KAT is considered. At the same time, KAT should not be abandoned in these very rare cases, especially when a nephron-sparing approach is otherwise not feasible. KAT can maintain renal function and quality of life and extend expectancy of life.
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Affiliation(s)
- Martin W W Janssen
- Department of Urology and Pediatric Urology, University of Saarland, Kirrbergerstr. 6, 66421, Homburg/Saar, Germany.
| | - Johannes Linxweiler
- Department of Urology and Pediatric Urology, University of Saarland, Kirrbergerstr. 6, 66421, Homburg/Saar, Germany
| | - Ines Philipps
- Department of Urology and Pediatric Urology, University of Saarland, Kirrbergerstr. 6, 66421, Homburg/Saar, Germany
| | - Zentia Bütow
- Department of Urology and Pediatric Urology, University of Saarland, Kirrbergerstr. 6, 66421, Homburg/Saar, Germany.,Present Address: Groupe Hospitalier Diaconesse Croix Saint Simon Service d'Urologie, Paris, France
| | - Stefan Siemer
- Department of Urology and Pediatric Urology, University of Saarland, Kirrbergerstr. 6, 66421, Homburg/Saar, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, University of Saarland, Kirrbergerstr. 6, 66421, Homburg/Saar, Germany
| | - Carsten-Henning Ohlmann
- Department of Urology and Pediatric Urology, University of Saarland, Kirrbergerstr. 6, 66421, Homburg/Saar, Germany
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Alameddine M, Moghadamyeghaneh Z, Yusufali A, Collazo AM, Jue JS, Zheng I, Morsi M, Prakash NS, Gonzalez J. Kidney Autotransplantation: Between the Past and the Future. Curr Urol Rep 2018; 19:7. [PMID: 29399714 DOI: 10.1007/s11934-018-0749-4] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
PURPOSE OF REVIEW The practice of kidney autotransplantation (KAT) has become an increasingly favorable approach in the treatment of certain renovascular, ureteral, and malignant pathologies. Current KAT literature describes conventional open procedures, which are associated with substantial risks. We sought to compare previously reported outcomes, evaluate common surgical indications, and assess associated risks and benefits of current KAT methods. A thorough evaluation and review of the literature was performed with the keywords "autologous transplantation" and "kidney." RECENT FINDINGS Early outcomes of robotic KAT are encouraging and have been associated with fewer complications and shorter hospital stay, but require robotic technique proficiency. KAT is an important method to manage selected complex urological pathologies. Robotic KAT is promising. Nevertheless, future studies should utilize larger patient cohorts to better assess the risks and benefits of KAT and to further validate this approach.
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Affiliation(s)
- Mahmoud Alameddine
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA.
| | - Zhobin Moghadamyeghaneh
- Department of Surgery, University of California San Francisco, San Francisco, CA, 94143, USA
| | - Ali Yusufali
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Alexa Marie Collazo
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Joshua S Jue
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Ian Zheng
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | - Mahmoud Morsi
- Miami Transplant Institute, University of Miami Miller School of Medicine, 1801 NW 9th Avenue, Miami, FL, 33136, USA
| | | | - Javier Gonzalez
- Hospital Central de la Cruz Roja, Universidad Alfonso X El Sabio, Madrid, Spain
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Расулов Р, Rasulov R, Муратов А, Muratov A, Дворниченко В, Dvornichenko V, Мориков Д, Morikov D, Тетерина Т, Teterina T. RENAL REPLANTATION AT EXTENDED AND COMBINED RESECTION OF RETROPERITONEAL LIPOSARCOMA (CASE REPORT). ACTA BIOMEDICA SCIENTIFICA 2017. [DOI: 10.12737/article_5955e6b68fe7c7.51729388] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Родион Расулов
- Иркутская государственная медицинская академия последипломного образования
| | | | | | | | | | | | - Дмитрий Мориков
- Иркутская государственная медицинская академия последипломного образования
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12
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Waldorf B, Lee Z, Kidd L, Kaplan J, Harris A, Metro M, Liu J, Eun D. Robotic Buccal Ureteroplasty: a Review of the Current Literature. Curr Urol Rep 2017; 18:40. [PMID: 28401476 DOI: 10.1007/s11934-017-0683-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
PURPOSE OF REVIEW This study aimed to provide an overview of the literature on buccal mucosal ureteroplasty for ureteral stricture disease, with a specific focus on the application of the robotic platform to buccal ureteroplasty. RECENT FINDINGS In our review, we highlight the results of Zhao et al. from the New York University School of Medicine Department of Urology, as well as our own results from Temple University Hospital. Zhao et al. published the first series of four patients who underwent robotic buccal ureteroplasty. Mean stricture length was 3.0 cm, and at a mean follow-up of 15 months, all repairs remained patent. We also describe our results in 10 patients who underwent robotic buccal ureteroplasty at Temple University Hospital. Median stricture length was 3.0 cm, and at a median follow-up of 5 months, all repairs remain patent. Robotic buccal ureteroplasty offers a promising option for repair of complex ureteral strictures.
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Affiliation(s)
- Benjamin Waldorf
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA.
| | - Ziho Lee
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Laura Kidd
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Joshua Kaplan
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Andrew Harris
- Paul B. Hall Regional Medical Center, Paintsville, KY, USA
| | - Michael Metro
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
| | - Jeffrey Liu
- Temple Head and Neck Institute, Temple University School of Medicine, Philadelphia, PA, USA
| | - Daniel Eun
- Department of Urology, Temple University School of Medicine, Philadelphia, PA, USA
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Sood A, Jeong W, Ahlawat R, Abdollah F, Sammon JD, Bhandari M, Menon M. Minimally invasive renal autotransplantation. J Surg Oncol 2015; 112:717-22. [PMID: 25995142 DOI: 10.1002/jso.23939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022]
Abstract
Minimally invasive renal allotransplantation techniques have been recently described; reported benefits include reduced morbidity/complications. These benefits have been successfully adapted for minimally invasive renal autotransplantation, however, in a non-oncological setting. We, here, describe a novel alternative robot-assisted renal autotransplantation technique, utilizing GelPOINT, which by permitting ex vivo graft examination and surgery might allow further broadening of indications for minimally-invasive renal autotransplantation, to include complex oncological renal/ureteral lesions. Future studies are needed to evaluate the utility of these techniques.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mahendra Bhandari
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
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Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability. J Urol 2015; 194:738-743. [PMID: 25801764 DOI: 10.1016/j.juro.2015.03.089] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/11/2015] [Indexed: 12/17/2022]
Abstract
PURPOSE Laparoscopic nephrectomy with autotransplantation is a viable option when renal preservation is required or ureteral reconstruction is impossible. In this study we report on our long-term experience with laparoscopic nephrectomy with autotransplantation. MATERIALS AND METHODS A retrospective review of data from all patients who underwent laparoscopic nephrectomy with autotransplantation since 2000 revealed data for 52 of 59 patients after study exclusions. Indications for laparoscopic nephrectomy with autotransplantation included ureteral stricture disease (41), renal malignancy (7), ptotic kidney (1), chronic flank pain (1), renal artery aneurysm (1) and renovascular hypertension (1). Followup included ultrasonography, nuclear renography and computerized tomography. Complications analyzed were Clavien-Dindo grade III or higher. RESULTS A total of 52 patients (30 women, 57.6%) underwent laparoscopic nephrectomy with autotransplantation at a median age of 48 years (range 12 to 76). At a median followup of 73.5 months 47 patients (90.3%) had long-term function of the autotransplanted renal unit including 3 of 4 (75%) solitary kidneys. There were 5 patients (9.7%) who experienced renal unit failure at a median of 15 months. Of these patients 3 required nephrectomy of autotransplant unit secondary to renal vein thrombosis (1 day), pseudoaneurysm (15 months) and chronic pain (48 months). Overall 4 patients had early complications and 8 had late complications. In the tumor group 4 patients had disease progression and all are alive. CONCLUSIONS Laparoscopic nephrectomy with autotransplantation is an excellent long-term surgical option (greater than 90% success rate with longer than 6-year median followup) for complex ureteral and renal conditions that necessitate preservation of renal parenchyma. However, tumor progression is possible after ex vivo tumor excision. Therefore, careful patient selection and followup are mandatory. This report supports the safety, efficacy and durability of laparoscopic nephrectomy with autotransplantation in experienced hands.
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Abstract
PURPOSE We describe a technique of complete intracorporeal renal autotransplantation with donor nephrectomy and transplantation performed in a minimally invasive fashion without extracting the kidney. MATERIALS AND METHODS We developed this technique of a completely intracorporeal robotic renal autotransplantation and determined the feasibility of this novel procedure. This includes a method of 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 a warm ischemia time of 2.3 minutes. Subsequently cold ischemia was achieved by intracorporeal hypothermic renal perfusion for 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 50 ml. There were no complications and the patient was discharged home on postoperative day 1 after normal Doppler transplant renal ultrasound. Postoperative renal scan at 6 weeks, intravenous urogram at 8 weeks and computerized tomography urography at 5 months revealed normal function and successful ureteral reconstruction. CONCLUSIONS We report the feasibility of a technique of a completely intracorporeal robotic renal autotransplantation. This operation may be considered in select patients in the hands of experienced robotic surgeons. However, further refinement is required as this novel procedure is cautiously reproduced and adopted by others.
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Renal autotransplantation for iatrogenic high-grade ureteric stricture. Case Rep Urol 2012; 2012:259527. [PMID: 23304622 PMCID: PMC3529440 DOI: 10.1155/2012/259527] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2012] [Accepted: 11/06/2012] [Indexed: 11/20/2022] Open
Abstract
A 47-year-old Hispanic woman developed a chronically obstructed left kidney, due to a long-segment ureteric stricture deemed not amenable to reimplantation, following left ovarian cyst excision in 2004. Therefore, a ureteral stent requiring exchange every 3 months was necessary, due to hydronephrosis, recurrent urosepsis, chronic pain, and a poor quality of life. Her medical history was complicated by hypertension, poorly controlled diabetes mellitus, and microalbuminuria, suggesting early diabetic nephropathy. A left nephrectomy was recommended. This was deferred, due to concern for progressive kidney failure associated with her comorbidities. A radionuclide Tc-99m MAG3 renal scan revealed differential perfusion as follows: 44% left kidney and 56% right kidney, with symmetrical uptake on the renogram phase and delayed excretion on the left, which were correctted following furosemide administration. A left ureteronephrectomy with autotransplantation of the left kidney and ureteroneocystostomy was performed in 2009. Since then, the patient has experienced no further complications or need for invasive procedures, with excellent diabetic control and stable renal function (eGFR > 60 mL/min/1.73 m2). This technique is seldom employed in the surgical management of complex ureteral injuries, but may be an alternative for appropriate cases.
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Corbetta JP, Durán V, Burek C, Weller S, Sager C, Dingevan R, Lopez JC. Renal autotransplantation for the treatment of renovascular hypertension in the pediatric population. J Pediatr Urol 2011; 7:378-82. [PMID: 21527221 DOI: 10.1016/j.jpurol.2011.02.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To evaluate the effectiveness of renal autotransplantation (RA) for the treatment of renovascular hypertension (RVH) in a selected group of children in whom medical care, a percutaneous transluminal angioplasty or vascular reconstruction failed or was technically impossible, in addition to the short-term and long-term morbidity. MATERIALS AND METHODS A retrospective case review of 13 pediatric patients with severe or complicated RVH who underwent RA between May 1993 and August 2008 was conducted. We defined blood pressure (BP) response as follows: Cured: normal BP values with no need of antihypertensive medication (AM); Improved: normal BP values with AM requirements; Failed: abnormal BP values despite treatment with AM. RESULTS 16 RA were performed in 7 female and 6 male patients. Bilateral RA were performed in 2 females and in 1 male. The average age at consultation for hypertension was 8.5 years (range 4-12 years) and the time of transplantation was 9.12 years (range 6-13 years). Etiological diagnoses were: Takayasu disease (n = 5); renal artery fibrodysplasia (n = 3); mid-aortic syndrome (n = 3) and neurofibromatosis type I (n = 2). Results after RA were: Cured: 61.5%; Improved: 38.5%. No patient presented therapeutic failure during follow up time (median = 53.4 months). Only 1 case presented a postoperative complication. CONCLUSIONS RA is a procedure with no mortality and low morbidity rates that renders very satisfactory therapeutic results in the pediatric population.
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Affiliation(s)
- Juan Pablo Corbetta
- Urology Department, Hospital de Pediatría Prof. Dr. Juan P. Garrahan, Buenos Aires, Argentina.
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Lee SE. Ex SituBench Surgery and Renal Autotransplantation. JOURNAL OF THE KOREAN MEDICAL ASSOCIATION 2008. [DOI: 10.5124/jkma.2008.51.4.365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Sang Eun Lee
- Department of Urology, Seoul National University College of Medicine, Korea.
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Eisenberg ML, Lee KL, Zumrutbas AE, Meng MV, Freise CE, Stoller ML. Long-term outcomes and late complications of laparoscopic nephrectomy with renal autotransplantation. J Urol 2007; 179:240-3. [PMID: 18001789 DOI: 10.1016/j.juro.2007.08.135] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2007] [Indexed: 12/11/2022]
Abstract
PURPOSE We report long-term outcomes and late complications after laparoscopic nephrectomy with autotransplantation. MATERIALS AND METHODS We retrospectively reviewed clinical data on all patients who underwent laparoscopic nephrectomy with autotransplantation between July 2000 and March 2007. Late complications, ie greater than 6 months, that required surgical intervention were analyzed. Clinical outcomes in patients with primary ureteral stricture disease and oncological outcomes in patients with renal tumors were examined. RESULTS Indications for autotransplantation included complex ureteral stricture disease in 15 patients and renal malignancy in 4. Median age at surgery was 48 years (range 25 to 68). Median followup was 29 months. Of the 17 patients with greater than 6 months of followup late complications requiring surgical intervention occurred in 4. Transplant nephrectomy was required in 2 patients in the stricture group. Indications for nephrectomy were nonfunction complicated by pseudoaneurysm in 1 case and chronic loin pain in 1. Another patient had recurrent nephrolithiasis requiring percutaneous nephrolithotomy and in 1 a pseudoaneurysm was managed successfully by endovascular techniques. Two patients in the tumor group had disease progression, which was managed medically. CONCLUSIONS Given the complexity and severity of disease that necessitates renal autotransplantation, it is not surprising that additional treatments are required. Patients with primary stricture disease may be at increased risk for vascular aneurysm due to infection and/or inflammation. Tumor progression is possible after ex vivo tumor excision and autotransplantation, especially in patients requiring heroic measures to avoid or delay dialysis. Thus, careful patient selection and vigilant followup are mandatory.
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Affiliation(s)
- Michael L Eisenberg
- Department of Urology, University of California-San Francisco, San Francisco, California 94143-0738, USA
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Abstract
PURPOSE The psoas hitch ureteral reimplant has been described in the literature as an excellent method to restore ureterovesical continuity in patients with ureteral defects of various etiologies. However, long-term data on the durability of this procedure are lacking. We retrospectively reviewed patients who underwent ureteral reconstruction using the psoas hitch reimplantation to determine long-term efficacy. MATERIALS AND METHODS Ureteral reimplantation in the adult is frequently performed in the setting of ureteral tissue loss secondary to resection or injury. The psoas hitch reimplantation is a simple, versatile technique that avoids the inclusion of intestinal segments and can be used in most patients requiring reimplantation. Indications for surgery and the long-term followup were examined in 20 patients undergoing reimplantation using the psoas hitch. RESULTS The indications for ureteral reconstruction included surgical injury in 13 cases, recurrent pyelonephritis with reflux in 1, obstruction secondary to cancer in 2, trauma in 1, retroperitoneal fibrosis in 1 and ureteral stricture in 2. At followup of 1 to 14 years (mean 6) 17 patients have not required further intervention for urological problems and have retained normal renal function. In the 2 patients with cancer ileal conduit was performed later and in 1 flank pain persisted despite negative urological evaluation. CONCLUSIONS Psoas hitch ureteral reimplantation can be used successfully for bridging various ureteral defects in difficult clinical situations. Adequate renal and bladder mobilization will allow reconstruction despite long ureteral defects.
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Affiliation(s)
- R Mathews
- James Buchanan Brady Urological Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA
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Chary KS, Rao MS, Palaniswamy R. Vesicopyelostomy using a tubed bladder flap-multiple psoas hitch technique to an orthotopic kidney. J Urol 1982; 127:129-31. [PMID: 7057484 DOI: 10.1016/s0022-5347(17)53641-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
A case is reported in which a long upper ureteral stricture, resulting from a failed pyeloureteroplasty, was repaired using a pedicle bladder tube. A vesico-psoas hitch was performed as the initial procedure. A 17 cm. long bladder flap was based posteriorly and extended across the dome and the anterior wall onto the contralateral posterolateral aspect of the bladder. Stepwise stretching and hitching of the bladder flap to the psoas major muscle at 5 places ensured successful bridging of the gap without compromising its vascularity. At followup cystography the bladder tube was noted to accommodate the reflux of contrast material, preventing its entry into the pelviocaliceal system. The patient regained a bladder capacity of about 300 ml. This procedure should be considered before ileal ureteral replacement or autotransplantation in cases of extensive ureteral loss.
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Ivancevic LD, Hohenfellner R, Wulff HD. Total replacement of the ureter using a bladder flap and cinematographic studies on the newly constructed ureter. J Urol 1972; 107:576-9. [PMID: 5014360 DOI: 10.1016/s0022-5347(17)61081-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
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Hardy JD, Timmis HH, Lamar Weems W, Wesson RL, Moore JD, Langford HG. Kidney transplantation in man: analysis of eleven cases. Ann Surg 1967; 165:933-46. [PMID: 5338165 PMCID: PMC1617532 DOI: 10.1097/00000658-196706000-00009] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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