Résumé
PURPOSE: To confirm the feasibility of the laparoendoscopic Pfannenstiel nephrectomy using conventional laparoscopic instruments. MATERIALS AND METHODS: Since March 2009, laparoscopic nephrectomy through a Pfannenstiel incision has been performed in selected patients in our service. The Veress needle was placed through the umbilicus which allowed carbon dioxide inflow. One 5 mm (or 10 mm) trocar was placed at the umbilicus for the laparoscope, to guide the placement of three trocars over the Pfannenstiel incision. Additional trocars were placed as follows: a 10 mm in the midline, a 10 mm ipsilateral to the kidney to be removed (2 cm away from the middle one), and a 5 mm contralateral to the kidney to be removed (2 cm away from the middle one). The entire procedure was performed using conventional laparoscopic instruments. At the end of the surgery, trocars were removed and all three incisions were united into a single Pfannenstiel incision for specimen retrieval. RESULTS: Five nephrectomies were performed following this technique: one atrophic kidney, one kidney donation, two renal cancers and one bilateral renal atrophy. Median operative time was 100 minutes and median intraoperative blood loss was 100 cc. No intraoperative complications occurred and no patients required blood transfusion. Median length of hospital stay was 1 day (range 1 to 2 days). CONCLUSIONS: The use of the Pfannenstiel incision for laparoscopic nephrectomy seems to be feasible even when using conventional laparoscopic instruments, and can be considered a potential alternative for traditional laparoscopic nephrectomy.
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Laparoscopie/instrumentation , Néphrectomie/instrumentation , Études de faisabilité , Laparoscopes , Laparoscopie/méthodes , Néphrectomie/méthodes , Instruments chirurgicaux , Facteurs temps , Résultat thérapeutiqueRésumé
In the past, morbid obesity was considered a relative contraindication to renal donation; however, more recent publications have shown that laparoscopic renal surgery is safe and effective for obese donor nephrectomy. We report the performance of a bariatric surgery before the kidney donation in 2 patients in order to improve their medical condition and to reduce their surgical risk to the transplantation procedure. After bariatric surgery, both donors lost more than 30 percent of their initial corporal weight and their donation procedure was successfully performed, with uneventful postoperative courses.
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Chirurgie bariatrique , Rein , Donneur vivant , Néphrectomie/méthodes , Obésité morbide/chirurgie , Prélèvement d'organes et de tissus/méthodes , Laparoscopie , Perte de poidsRésumé
PURPOSE: Laparoscopic live donor nephrectomy has acquired an important role in the era of minimally invasive surgery. Laparoscopic harvesting of the right kidney is technically more challenging than that of the left kidney because of the short right renal vein and the need to retract the liver away from the right kidney. The aim of this article is to report our experience with right laparoscopic live donor nephrectomies. MATERIALS AND METHODS: We performed a retrospective review of 28 patients who underwent right laparoscopic donor nephrectomies at our service. Operative data and postoperative outcomes were collected, including surgical time, estimated blood loss, warm ischemia time, length of hospital stay, conversion to laparotomy and complications. RESULTS: The procedure was performed successfully in all 28 patients. The mean operative time was 83.8 minutes (range 45 to 180 minutes), with an estimated blood loss of 111.4 mL (range 40 to 350 mL) and warm ischemia time of 3 minutes (range 1.5 to 8 minutes). No donor needed conversion to open surgery and all kidneys showed immediate function after implantation. The average time to initial fluid intake was 12 hours (range 8 to 24 hours). Two cases of postoperative ileus and a case of hematoma on the hand-port site were observed. The mean postoperative hospital stay was 3 days (range 1 to 7 days). CONCLUSIONS: Our data confirm the safety and feasibility of right laparoscopic donor nephrectomy and we believe that the right kidney should not be avoided for laparoscopic donor nephrectomy when indicated.
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Rein/anatomie et histologie , Laparoscopie , Donneur vivant , Néphrectomie/méthodes , Prélèvement d'organes et de tissus/méthodes , Études de faisabilité , Rein/vascularisation , Études rétrospectivesRésumé
Pelvic surgery is the most common cause of iatrogenic ureteral injury, and traditionally repair of such injuries requires laparotomy. We report the case of a 48-year-old woman with an iatrogenic ureteral injury after laparoscopic ophorectomy which was laparoscopically reimplanted using the Lich-Gregoire technique. Total operating time was 150 minutes and estimated blood loss was 100 mL. Two months after surgery she is asymptomatic with normal renal function.
Sujets)
Femelle , Humains , Adulte d'âge moyen , Uretère/chirurgie , Obstruction urétérale/étiologie , Procédures de chirurgie gynécologique/effets indésirables , Procédures de chirurgie gynécologique/méthodes , Laparoscopie/effets indésirables , Laparoscopie/méthodes , Soins postopératoires , Complications postopératoires/étiologie , Complications postopératoires/chirurgie , /méthodes , Résultat thérapeutique , Uretère/traumatismes , Uretère/anatomopathologieRésumé
Laparoscopic donor nephrectomy has become the standard of care at increasing numbers of renal transplant programs worldwide. The majority of laparoscopic living donor kidneys are procured from the left side because of the longer renal vein and improved transplantation. The aim of this article is to report a technique to maximize the right renal vein length by performing a hand-assisted cavotomy.