Three-dimensional laparoscopy for living-donor nephrectomy

25 février 2017

Auteurs : X. Gamé, M. Binhazzaa, M. Soulié, N. Kamar, F. Sallusto
Référence : Prog Urol, 2017, 2, 27, 47-48




 


Dear editors,

Renal transplantation from living donors is now a common surgical procedure due to the shortage in deceased donors and the improvements in graft survival. Laparoscopic kidney removal is the current gold standard. We report here the first case of nephrectomy for kidney donation using 3D laparoscopy.


A 35-year-old man was referred in order to perform a left nephrectomy to donate his kidney to one of his friends. He had no significant medical history. Preoperative computed tomography showed two left renal arteries, a renal vein and a ureter.


The procedure was performed under general anaesthesia using an HD S 3D column (Karl Storz, Tuttlingen, Germany) (Figure 1). No specific instrument was required. As used for 2D laparoscopic living-donor nephrectomies, the used instruments were a bipolar forceps, a forceps, scissors and a thermofusion forceps (Ligasure®, Covidien-Medtronic, Dublin, Ireland). The patient was placed in the lateral position and four ports were put in place: one 12mm port, one 10mm and two 5mm.


Figure 1
Figure 1. 

View of the operating room during the 3D laparoscopiy for living-donor nephrectomy.




The procedure was carried out in the usual way. The left colon was moved to expose the kidney. The gonadal vein was moved in line with the renal vein. The upper edge of the renal vein was mobilised and the adrenal vein controlled and severed by thermofusion. The kidney upper pole was mobilised, and the gonadal and azygos veins controlled and severed by thermofusion. The renal arteries were mobilised up to their ostia and the ureter up to where it crosses the iliac artery. The kidney was completely released. A left pararectal incision was made into the iliac fossa and a wound retractor (Alexis®, Applied medical, Rancho Santa Margarita, CA, USA) placed, into which an endobag was introduced. After sectioning the ureter between two Hem-o-loks (Teleflex, Wayne, PA, USA) at its crossing point with the iliac artery, the kidney was placed into the endobag and the arteries and the vein each clamped and sectioned. The kidney was removed and washed.


The warm ischemic time was 1min 50sec and the operative time was 90min. There was no loss of blood and no intraoperative or postoperative complications. The patient was discharged on the second postoperative day. The transplanted organ behaved as expected, with the recovery of renal function on the same evening as the intervention.


This report demonstrates the feasibility of using 3D laparoscopy for nephrectomy for kidney donation. The value of 3D vision in performing nephrectomies for kidney donation has already been demonstrated for robotic surgery [1]. However, this uses older technology than that used here and allows only the operator a three-dimensional view, an important limiting factor when operational assistance is required, especially when clamping the vessels. Moreover, the lack of force feedback and its high cost are additional limitations to the wide uptake of this technology [2].


This is the first report to date showing the use of 3D laparoscopy to perform nephrectomy in humans. The new generation 3D laparoscopy used here allows for a more in-depth vision, greater overall definition of planes, better accuracy of dissection and reduced operative times. This is in line with reported results on other urological interventions, such as adrenalectomy and cystectomy [3, 4]. For the operator, there was also reduced stress in the upper arms and eyes and a lower risk of headaches [4]. As 3D laparoscopy does not require any specific instrument apart from the video system and the optic (prize: around 80 000 Euros), the additional cost is limited as compared to 2D surgery and is hugely lesser than robotic assisted laparoscopy. It therefore appears that 3D laparoscopy could gradually replace 2D techniques in urological surgery.


Thus, for nephrectomy, and especially in cases of kidney donation, additional studies are now needed to establish the benefits of this technique.


Disclosure of interest


The authors declare that they have no competing interest.



References



Giacomoni A., Di Sandro S., Lauterio A., Concone G., Buscemi V., Rossetti O., et al. Robotic nephrectomy for living donation: surgical technique and literature systematic review Am J Surg. 2016 ;  211 : 1135-1142 [cross-ref]
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Agrusa A., di Buono G., Chianetta D., Sorce V., Citarrella R., Galia M., et al. Three-dimensional (3D) versus two-dimensional (2D) laparoscopic adrenalectomy: a case-control study Int J Surg. 2016 ;  28 : S114-S117






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Elsevier Masson SAS. Tous droits réservés.