Vorbereitung zur klinischen Etablierung fortgeschrittener urologischer Operationstechniken

Laparoscopic inferior mesenteric-gonadal vein bypass for the treatment of nutcracker syndrome

Nutcracker syndrome is a rare entity caused by extrinsic compression on the left renal vein (LRV) crossing between the superior mesenteric artery and the aorta. This article reports the treatment of two cases of nutcracker syndrome using laparoscopic inferior mesenteric-gonadal vein bypass, knowing that this treatment option would avoid renal reperfusion injury and LRV hypertension. In addition, it is easier to operate compared with laparoscopic splenorenal venous bypass and laparoscopic transposition of LRV into the inferior vena cava.

Comparison of 2 devices in pigs to induce hypothermia in laparoscopic orthotopic kidney transplant

OBJECTIVES

To laparoscopically compare the effectiveness of 2 cooling devices for renal hypothermia and investigate the feasibility of laparoscopic orthotopic kidney transplant using a pig model.

MATERIALS AND METHODS

Eight pigs were divided into 2 groups of 4 animals each. Laparoscopic nephrectomy and autotransplant were performed first on only the right kidney. One week later, these procedures were performed on the left kidney, while the first transplanted autograft was removed. After 1 more week, the left autograft was removed for observation. In 1 group, the silicon tube cage was used to induce hypothermia during laparoscopic orthotopic kidney transplant (silicon tube cage group), and in the other group, the plastic bag jacket was used to induce hypothermia during laparoscopic orthotopic kidney transplant (plastic bag jacket group).

RESULTS

Two pigs in the silicon tube cage group survived for 7 days after the second autotransplant with serum creatinine levels of 210 μmol/L and 1010 μmol/L. One pig in the plastic bag jacket group survived for 5 days. The mean surface temperature of the grafts was maintained at 9°C ± 3°C and 12°C ± 3°C in the silicon tube cage and plastic bag jacket groups (P = .166). Three of 6 plastic bag jacket devices were ruptured by stitches or instruments. The mean venous and arterial anastomotic times in the silicon tube cage group were significantly shorter than were those in the plastic bag jacket group.

CONCLUSIONS

Our study shows that the silicon tube cage may be a reliable renal cooling device for use in laparoscopic kidney transplant and indicates the feasibility of laparoscopic orthotopic kidney transplant in pigs.

Management of renal nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vivo autograft repair and autotransplantation: a case report and review of the literature

Introduction

Nutcracker syndrome (NCS) is caused by a compression of the left renal vein between the aorta and the superior mesenteric artery (SMA). It results in left renal venous hypertension, and the subsequent development of venous varicosities of the renal pelvis, ureter, and gonadal vein.

Case presentation

A 21-year-old Chinese woman was admitted with a seven-month history of unilateral severe hematuria. On admission, she was identified as having nutcracker syndrome. The patient was treated with retroperitoneal laparoscopic donor nephrectomy and renal autotransplantation. The patient underwent retroperitoneal laparoscopic donor nephrectomy using a retroperitoneal three-port technique with ex vitro autograft repair and subsequent renal autotransplantation into the iliac fossa. In order to shorten the hot ischemia time and improve the patient's cosmetic outcome, a minor oblique incision in the left, lower quadrant was prepared in advance of the laparoscopic donor nephrectomy for use as a site for the autograft to be procured through the retroperitoneal space and as a transplant site for the autograft. Two days after the operation, the patient's symptoms subsided. Serum creatinine before and after the operation were 53 mmol/L and 55 mmol/L, respectively. The patient had normal renal function during a follow-up three months after the operation.

Conclusion

The treatment of nutcracker syndrome by retroperitoneal laparoscopic nephrectomy with ex vitro repair and autotransplantation is a simpler and less invasive procedure than open surgery. Moreover, a minor incision on the left hypogastrium can shorten the autograft's hot ischemic time and improve patients' cosmetic outcomes, especially in young women.