Long-Term Outcomes and Late Complications of Laparoscopic Nephrectomy With Renal Autotransplantation

Eisenberg, Michael L.; Lee, Keith L.; Zümrütbaş, Ali Ersin; Meng, Maxwell V.; Freise, Chris E.; Stoller, Marshall L.

doi:10.1016/j.juro.2007.08.135

Cited by 65 publications

(42 citation statements)

References 18 publications

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“…9,11 Thus, in cases similar to our present case, physicians should consider laparoscopic nephrectomy, ex vivo renal artery revascularization, and renal autotransplant as alternate procedures.…”

Section: Discussionsupporting

confidence: 57%

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Ogawa¹,

Yanagida²,

Kataoka³

et al. 2012

Exp Clin Transplant

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We describe in this report the case of a renal aneurysm in a 42-year-old woman. The aneurysm measured 27 mm in diameter, and was sited at the first bifurcation of the renal artery. We performed laparoscopic nephrectomy, ex vivo angioplasty and renal autotransplant to avoid ischemic damage to the kidney during reconstruction. The patient recovered and was discharged from the hospital without any complications. Hence, we suggest these treatments can be effectively done in patients with complex renal aneurysms. Key words: Renal artery aneurysm, Laparoscopic nephrectomy, Extracorporeal reconstruction, Renal autotransplantation, Renal functionSince renal autotransplant was first described by Hardy in 1963, 1 it has been used to treat patients with renovascular diseases, ureter injuries, and renal tumors. We present the case report of a patient with a renal artery aneurysm who underwent nephrectomy, ex vivo angioplasty of the renal artery, and renal autotransplant who recovered without complications. Case ReportA 42-year-old woman visited the district general hospital, complaining of a history of continuous fever and fatigue. Her urine was clear; however, results of screening abdominal ultrasonography revealed a hypoechoic mass in the upper part of the right kidney. Doctors there suspected a right renal artery aneurysm and referred her to our hospital. On admission, her blood pressure was normal, and serum creatinine and blood urea nitrogen concentrations were within normal ranges. Results of 3-dimensional computed tomography (CT) and selective renal angiography showed a saccular right renal artery aneurysm measuring 27 mm in diameter (Figures 1 and 2). From these images, we also ascertained that the aneurysm originated from the first bifurcation of the renal artery. Results of a subsequent renogram showed normal split renal function of the bilateral kidney. The CT and angiography results indicated that endovascular coil embolization was impossible, owing to the morphology and site of the aneurysm. Based on these findings, the patient was scheduled for laparoscopic nephrectomy, ex vivo repair, and autotransplant.The patient was placed in the lateral decubitus position with the left side down. Three 12-mm ports and a 5-mm port were inserted into the retroperitoneal space. After dissection of the renal hilum, the right renal artery and the aneurysm were

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Section: Discussionsupporting

confidence: 57%

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Ogawa¹,

Yanagida²,

Kataoka³

et al. 2012

Exp Clin Transplant

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“…During the last 2 y, there have been three reports on Auto-Tx by laparoscopic kidney extraction and a separate incision or extension of the kidney harvesting incision for reimplantation [8][9][10]. However, in these reports, MI techniques have quite clearly not been used during implantation, and the exact length of the Tx-incisions has not been accounted for.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Renal Auto-Transplantation: The First Report

Øyen

Lien

Line

et al. 2010

Journal of Surgical Research

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“…1 It has been successfully used in the management of complex kidney pathology such as extensive ureteral injuries, renal artery aneurysms, renovascular hypertension, difficult centrally located renal tumors and chronic flank pain. 2,3 It also serves as an alternative to immediate nephrectomy and dialysis for patients with preexisting renal failure or a solitary kidney. 4,5 For complex renal tumors and vascular anomalies, ex vivo repair offers the advantages of open surgical reconstruction.…”

mentioning

confidence: 99%

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

et al. 2015

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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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Long-Term Outcomes and Late Complications of Laparoscopic Nephrectomy With Renal Autotransplantation

Cited by 65 publications

References 18 publications

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Laparoscopic Nephrectomy, Ex Vivo Angioplasty, and Renal Autotransplant for a Renal Artery Aneurysm: A Case Report

Minimally Invasive Renal Auto-Transplantation: The First Report

Laparoscopic Nephrectomy with Autotransplantation: Safety, Efficacy and Long-Term Durability

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