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Minimal incision ipsilateral dual kidney transplantation
Urology Video Journal 4 (2019) 100012
Contents lists available at ScienceDirect
Urology Video Journal journal homepage: www.elsevier.com/locate/urolvj
Minimal incision ipsilateral dual kidney transplantation Giovanni Varotti , Giulia Atzori, Iris Fontana Kidney Transplant Unit, Department of Surgery, San Martino University Hospital, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
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Keywords: Dual kidney transplantation Mini-incision Minimally invasive surgery
a b s t r a c t Objective: Dual kidney transplantation (DKT) was developed because allows the utilization of suboptimal kidneys procured from extended criteria donors. Compared to single kidney transplant, DKT is a demanding procedure, with higher risk of complications1–3 . In 2006, a mini-invasive technique has been introduced in single kidney transplant, using a minimal incision of 5-8 cm of length4–7 . We describe a novel minimally invasive technique of ipsilateral dual kidney transplantation, using a 8 cm of length mini-incision. Patients and methods: The patient was a 67-year-old male, with an end-stage renal disease secondary to a glomerulonephritis, who received two kidneys from a 73-year-old woman, deceased for subarachnoid haemorrhage. Pretransplant renal biopsies showed a Remuzzi–Karpinski score of 4 and 5. Results: Surgical time was 220 min. Warm ischemia times were of 33 min and 31 min, respectively. Post-operative course was uneventful and on POD 11, the patient was discharged in good condition with a normal renal function (creatinine level: 1.0 mg/dl). He remains in healthy conditions with regular kidney function after eighteen months of follow-up. Conclusions: Minimal incision ipsilateral dual kidney transplantation (MIDKT) seems technically feasible. Surgical time and warm ischemia times were comparable to those obtained using the conventional technique. Reduced post-operative pain, cosmetic result, absence of complications and good graft function seem promising. MIDKT seems to add the positive aspects of a conventional surgery as the easy achievability and the low costs, to those of a mini-invasive surgery, such as reduced trauma, reduced pain, better cosmetic and faster recovery.
Supplementary material The video related to this article can be found online at: doi:10.1016/j.urolvj.2019.100012. References [1] L.B. Johnson, P. Kuo, D.C. Dafoe, et al., Double adult renal allografts: a technique for expansion of the cadaveric kidney donor pool, Surgery 120 (1996) 580–584. [2] J. Gill, Y.W. Cho, Danovitch, et al., Outcomes of dual adult kidney transplant in the United States: an analysis of the OPTN/UNOS database, Transplantation 85 (2008) 62–68.
[3] A. Osama Gaber, H. Shokouh-Amiri, N. Nezakatgoo, et al., Ipsilateral placement in double-kidney transplantation, Transplantation 84 (2007) 929–931. [4] R. Uwechue, P. Chandak, Z. Ahmed, et al., Minimally invasive surgical techniques for kidney transplantation (Protocol), Cochrane Datab. Systematic Rev. 7 (2017) 1–13. [5] O. Oyen, T. Scholz, A. Hartmann, P. Pfeffer, Minimally invasive kidney transplantation: the first experience, Transpl. Proc. 38 (2006) 2798–2802. [6] S.H. Phillips, S.K. Hill, L.D. Lipscomb, J. Africa, Altering the approach: open minimally invasive renal transplant in obese patients through the anterior rectus sheath, Urology 39 (2017) 114–118. [7] S.H. Phillips, S.K. Hill, L.D. Lipscomb, J.B. Africa, First experience: open small incision rectus sheath approach renal transplant: a case series, Int. J. Surg. 39 (2017) 114–118.
Corresponding author. E-mail address: [email protected] (G. Varotti). https://doi.org/10.1016/j.urolvj.2019.100012 Received 5 June 2019; Received in revised form 11 September 2019; Accepted 12 September 2019 2590-0897/© 2019 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)
Contents lists available at ScienceDirect
Urology Video Journal journal homepage: www.elsevier.com/locate/urolvj
Minimal incision ipsilateral dual kidney transplantation Giovanni Varotti , Giulia Atzori, Iris Fontana Kidney Transplant Unit, Department of Surgery, San Martino University Hospital, Largo Rosanna Benzi, 10, 16132 Genoa, Italy
a r t i c l e
i n f o
Keywords: Dual kidney transplantation Mini-incision Minimally invasive surgery
a b s t r a c t Objective: Dual kidney transplantation (DKT) was developed because allows the utilization of suboptimal kidneys procured from extended criteria donors. Compared to single kidney transplant, DKT is a demanding procedure, with higher risk of complications1–3 . In 2006, a mini-invasive technique has been introduced in single kidney transplant, using a minimal incision of 5-8 cm of length4–7 . We describe a novel minimally invasive technique of ipsilateral dual kidney transplantation, using a 8 cm of length mini-incision. Patients and methods: The patient was a 67-year-old male, with an end-stage renal disease secondary to a glomerulonephritis, who received two kidneys from a 73-year-old woman, deceased for subarachnoid haemorrhage. Pretransplant renal biopsies showed a Remuzzi–Karpinski score of 4 and 5. Results: Surgical time was 220 min. Warm ischemia times were of 33 min and 31 min, respectively. Post-operative course was uneventful and on POD 11, the patient was discharged in good condition with a normal renal function (creatinine level: 1.0 mg/dl). He remains in healthy conditions with regular kidney function after eighteen months of follow-up. Conclusions: Minimal incision ipsilateral dual kidney transplantation (MIDKT) seems technically feasible. Surgical time and warm ischemia times were comparable to those obtained using the conventional technique. Reduced post-operative pain, cosmetic result, absence of complications and good graft function seem promising. MIDKT seems to add the positive aspects of a conventional surgery as the easy achievability and the low costs, to those of a mini-invasive surgery, such as reduced trauma, reduced pain, better cosmetic and faster recovery.
Supplementary material The video related to this article can be found online at: doi:10.1016/j.urolvj.2019.100012. References [1] L.B. Johnson, P. Kuo, D.C. Dafoe, et al., Double adult renal allografts: a technique for expansion of the cadaveric kidney donor pool, Surgery 120 (1996) 580–584. [2] J. Gill, Y.W. Cho, Danovitch, et al., Outcomes of dual adult kidney transplant in the United States: an analysis of the OPTN/UNOS database, Transplantation 85 (2008) 62–68.
[3] A. Osama Gaber, H. Shokouh-Amiri, N. Nezakatgoo, et al., Ipsilateral placement in double-kidney transplantation, Transplantation 84 (2007) 929–931. [4] R. Uwechue, P. Chandak, Z. Ahmed, et al., Minimally invasive surgical techniques for kidney transplantation (Protocol), Cochrane Datab. Systematic Rev. 7 (2017) 1–13. [5] O. Oyen, T. Scholz, A. Hartmann, P. Pfeffer, Minimally invasive kidney transplantation: the first experience, Transpl. Proc. 38 (2006) 2798–2802. [6] S.H. Phillips, S.K. Hill, L.D. Lipscomb, J. Africa, Altering the approach: open minimally invasive renal transplant in obese patients through the anterior rectus sheath, Urology 39 (2017) 114–118. [7] S.H. Phillips, S.K. Hill, L.D. Lipscomb, J.B. Africa, First experience: open small incision rectus sheath approach renal transplant: a case series, Int. J. Surg. 39 (2017) 114–118.
Corresponding author. E-mail address: [email protected] (G. Varotti). https://doi.org/10.1016/j.urolvj.2019.100012 Received 5 June 2019; Received in revised form 11 September 2019; Accepted 12 September 2019 2590-0897/© 2019 The Author(s). Published by Elsevier Inc. This is an open access article under the CC BY-NC-ND license. (http://creativecommons.org/licenses/by-nc-nd/4.0/)