Intra-Abdominal Cooling System Limits Ischemia-Reperfusion Injury During Robot-Assisted Renal Transplantation.

Robot-assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra-abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra-abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p-values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia-reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot-assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra-abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia-reperfusion injuries.

[Robotic-assisted organ transplantation]. / Transplantation d'organes avec assistance robotique.

Advanced surgical procedures have traditionally been a domain of open surgery. However, minimally invasive approaches are evolving with the development of robotic technology which appears capable to overcome technical limitations of conventional laparoscopy. While traditionally perceived as impossible indications for minimally invasive surgery, reports on robotic organ transplantations have surfaced with promising results.

[The viability of kidneys tested by gadolinium-perfusion MRI during ex vivo perfusion]. / La viabilité des reins marginaux testée par perfusion de gadolinium sous IRM pendant leur réanimation.

INTRODUCTION: Marginal kidneys must be reanimated before their transplantation. Reanimation is conducted with hypothermic pulsatile perfusion. The tests used generally to demonstrate the viability is the vascular resistance which is not convenient for everybody. We have developed a magnetic resonance compatible perfusional technology allowing us to test the organs during the perfusion by Gd-perfusion MRI. METHODS AND RESULTS: We have used pigs' kidneys with no warm ischemic time to establish the basis in a normal kidney. After an eight-hour hypothermic pulsatile perfusion, kidneys are submitted to a Gd perfusion. First, we measure the anatomy of the vessels, then the distribution of Gd in the kidney. We obtain simultaneously a dynamic study of the organs where T0 represents the Gd bolus arrival in the cortex and TP the maximum saturation time of Gd. CONCLUSION: We have observed that a normal T0 is inferior to 30s and TP is inferior to one minute. We have compared these values with ATP resynthesis in these organs and found that they correlate. We hope for the future through that predictive use of Gd-MRI to avoid the clinical use of "too" marginal kidneys or the discard of good kidneys but not corresponding with the vascular resistance theory.

Arthropump with peristaltic effect and pulsatile flow.

This paper describes a pump of novel design, with peristaltic effect and pulsatile flow. Special features are the facility for occlusive or non-occlusive pumping, and the absence of moving parts in the flow section. A compressible drive medium allows 'individual' transport of big particles in the pumped fluid. Pumping of a relatively high proportion of solids in liquid is possible. This pump is suitable for handling living structures in cell and tissue separating systems. Pumping of fluids with increased viscosity and abrasives in liquid is also feasible.

Blood supply of the median nerve in the carpal tunnel.

The importance of the arterial blood supply of the median nerve in the carpal tunnel depending on the type of hand vascularization was examined in view of surgical intervention in this region. Special attention was given to the anastomoses of the arterial branches which take part in the median nerve blood supply.

[Circulatory repercussions of arteriovenous fistulae at the carpal tunnel level]. / Les répercussions circulatoires au niveau du tunnel carpien des fistules artério-veineuses.

From a series of 84 cases of arterio-venous fistula, created for regular haemodialysis in end-stage chronic renal failure patients, the authors observed only one case of median nerve pathology at the level of the carpal tunnel. They propose three aetiologies: segmental ischaemia of the median nerve from perfusional redistribution, a mononeuritis syndrome aggravated by ischaemia and extrinsic compression of the median nerve by oedema secondary to distal venous reflux following creation of the vascular anastomosis. The authors recommend a termino-lateral anastomosis of a superficial vein (the superficial radial or the cephalic) with the radial artery. Using this approach, they did not observe any distal oedema nor any venous reflux into the hand. When a carpal tunnel syndrome is discovered in a case of arterio-venous fistula, the patient needs to be investigated for venous reflux into the hand and needs fistulography to exclude aspiration of blood from the cubital artery by the palmar arcade.

[Ability of cadaver kidneys to recover]. / Essai de récuperation de reins de cadavres.

The scarcity in brain death donors may impose to use kidneys from non-heart-beating donors. In this paper, we have studied the injuries due to warm in situ ischemia, we also propose a pretreatment to protect the kidneys before removal. We propose the use of intra-aortic catheter for flushing by a femoral surgical approach. Functional studies of these kidneys have been performed during 2 h normothermic ex-vivo perfusion and the recognized good organs have been successful reimplanted after 24 h of cold ischemia.

[Long-term results of perforated gastro-duodenal ulcers]. / Résultats à long terme des ulcères gastro-duodénaux perforés.

Two series of perforated duodenal ulcers are studied: 27 cases without anamnesis and 55 cases with medical or surgical treatment before the operations. All operated patients have a long catamnesis (five years and more). 50% of the patients are healed with a suture. Vagotomy and pyloroplasty are not associated. Gastrectomy is performed when the operated has an ulcer story.

[Renal artery stenosis following kidney transplantation -- an avoidable complication?]. / La sténose de l'artère rénale après transplantation est-elle une complication évitable?

Many etiologies have been proposed for renal artery stenosis following renal transplantation. Incorrect operative technique is the most frequent cause, but the condition is often due to vascular parietal lesions resulting from traction on the vessels during removal of kidneys, which causes dislocation of arterial parietal structures. Such traction is inevitable if kidneys are removed separately due to difficulties arising during deep mobilization of the kidneys. Furthermore, this technique involves direct flushing into the renal artery, and this may cause damage to the intima due to the canula. Canula and traction are the major causes of stenosis. The authors present their own cases and propose that kidneys be removed "en bloc". This is the only way to prevent traction on vessels, and it permits flushing through the aorta for cooling.