Van Praet Charles, Lambert Edward, Desender Liesbeth, Van Parys Benjamin, Vanpeteghem Caroline, Decaestecker Karel
Department of Urology, Ghent University Hospital, Ghent, Belgium.
Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium.
Front Surg. 2020 Dec 11;7:65. doi: 10.3389/fsurg.2020.00065. eCollection 2020.
Kidney autotransplantation can be performed in patients with complex renal or ureteral pathology not suitable for 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. 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. 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. We demonstrated feasibility and, for the first time, a surgical video of tiRAKAT highlighting patient positioning, trocar placement, and intracorporeal cold ischemia technique.
肾脏自体移植可用于患有复杂肾脏或输尿管病变而不适于重建的患者，如肾血管异常、近端或长段复杂输尿管狭窄患者或复杂肿瘤病例。机器人辅助手术可实现高质量的血管和输尿管吻合，并使患者恢复更快。机器人辅助肾脏自体移植（RAKAT）分两个阶段进行：肾切除术和盆腔移植术。在此期间，肾脏的取出便于在体外进行血管重建或肾脏修整，并可建立安全的冷缺血状态。如果不需要体外重建，完全体内RAKAT（tiRAKAT）是可行的。欧洲已有一例病例报告；然而，据我们所知，尚无手术视频。一名58岁女性10年前因宫颈癌接受盆腔放疗后出现右侧输尿管中下段狭窄。放置了双J支架，但她反复发生尿路感染，最终进行了肾造瘘术。肾图显示右侧肾脏相对功能为43%。由于放疗后她的膀胱容量较小，无法进行鲍里皮瓣手术，且患者拒绝长期肾造瘘或肾切除术。因此，使用达芬奇Xi系统进行了tiRAKAT。我们描述了我们的手术技术，包括一段视频。手术时间（皮肤到皮肤）为5小时45分钟。热缺血时间为4分钟，冷缺血时间为55分钟，复温缺血时间为15分钟。术后第一天和第二天分别拔除腹腔导管和膀胱导管。4周后拔除双J支架。患者术后第二天发生肺栓塞，开始使用治疗性低分子量肝素。术后前90天未发生进一步并发症。7个月后，总体肾功能保持稳定，肾闪烁显像显示右侧肾功能从27 mL/min降至25.2 mL/min，下降不显著（-6.7%）。我们证明了tiRAKAT的可行性，并首次展示了一段突出患者体位、套管针放置和体内冷缺血技术的tiRAKAT手术视频。
