Hand-Assisted Laparoscopic Living Donor Nephrectomy and Distal Pancreatectomy for Simultaneous Pancreas and Kidney Transplant

Abstract

We have recently reported the successful utilization of kidneys from patients with incidentally detected small renal tumours(< 3cm) for transplantation (Nicol et al BJU Int 2008. Following ex-vivo excision of the lesion and repair of the parenchymal defect the kidney is transplanted into selected recipients. These restored kidney transplants(RKT) appear a novel means of increasing the possibility of transplantation for selected patients who may otherwise not receive a transplant. To date we have performed 49 RKT with a median followup of 40 months. The kidneys were obtained from patients who had elected to undergo ablative nephrectomy for small renal tumours after discussions with their treating urologist of the alternative treatment options of partial nephrectomy, percutaneous ablative techniques and observation. Recipients were older patients with signifi cant co-morbidities that may have prevented them otherwise receiving a transplant following a rigourous informed consent process outlining the risk of tumour recurrence(5%) as well as tchnical complications including bleeding and urinary fi stula. One graft failure occured due to recurrent FSGS after 30 months and 4 patient deaths from unrelated causes. The remaining transplants continue to function. Four patients experienced technical complications requiring re-intervention. One patient developed a calyceal fi stula which was successfully repaired by open exploration with nephrostomy drainage and ureteric stenting. An arteriovenous malformation occured in another case. This was managed by selective embolisation without compromise to graft function. A further 2 patients required re-exploration for evacuation of haematoma. One recipient developed a small local recurrence 9 years following transplantation.To date the patient has declined intervention and the tumour remains stable at 1.2cm after 18 months of observation. In this video we demonstrate the donor nephrectomy procedure with the subsequent ex-vivo surgery to excise the tumour. Repair of the parenchymal defect including collecting system repair is then undertaken before transplantation. Utilising standard techniques employed for partial nephrectomy kidneys removed with small renal tumours appear a viable and novel source of transplantation for selected recipients. Background: It is seriously important for living donations to make safer and to reduce operating stress. Laparoscopic surgery is though to be a useful operating procedure for solving these problems. We have been performing pure retroperitoneoscopic nephrectomy for living kidney donation to decrease morbidity and reduce donor disincentives since April 2004. However, in living donor operation for simultaneous pancreas and kidney transplants (SPKTx), we had performed by open approach. In the last donation of SPKTx, We started hand-assisted laparoscopic living donor nephrectomy and distal pancreatectomy. In this presentation, we report a successfully completed handassisted laparoscopic living donor nephrectomy and distal pancreatectomy. Patient a...