A surgical team from the Toulouse University Hospital performed a kidney auto-transplantation without opening the patient’s abdomen. The operation, carried out under robotic assistance, is a first in Europe.
Thanks to robotic surgery, the urology team at Toulouse hospital achieved a surgical feat: repairing the urethra by kidney auto-transplantation, without having to open the patient’s abdomen. .
While it was previously considered a heavy and risky operation, the intervention required only 6 small abdominal incisions for the patient, who was able to return home after three days of hospitalization.
A patient who suffered a serious accident
The operation took place on a 29-year-old patient, victim in October 2017 of a serious road accident as a passenger. She suffered from severe abdominal trauma: intraperitoneal bleeding, removal of a large part of the intestine and significant deterioration of the abdominal wall. First operated at the Bigorre Hospital Center, in Tarbes where she underwent three laparotomies (opening of the abdomen) including two in emergency, she was then transferred to the Toulouse hospital in Rangueil, where she was taken care of. by the urology surgical team to treat his urethra and left kidney, both affected. “My ureter was broken, we had to think about what happened next. I left the hospital with a nephrostomy (a probe connected to a urine collection bag). I kept it for four long, very long months… Daily life was complicated, I had to be careful to dress myself when I already had the constraint of the corset. My only obsession was to get rid of my nephrostomy, “says Charlotte to The Dispatch.
Supported by the urologist surgeon Nicolas Doumerc, the young woman decides to trust him when the latter talks to her about performing, under robotic assistance, a kidney self-transplantation without opening her belly. “I trusted him with my eyes closed. I already had a meter of scars on my stomach. I didn’t want 40 cm more, my stomach was going to look like a highway… This operation represented a lot of stress in my entourage, but, for me, it’s a liberating moment!”
Minimally invasive surgery
To perform the operation, Dr. Doumerc was inspired by an advanced surgical technique for repairing the urethra already performed in the United States and Canada. This operation, unprecedented in Europe, allowed the patient to keep her left kidney. Rather than replacing the damaged part of the urethra with a piece of small intestine or removing the left kidney, the specialist turned to the solution of kidney auto-transplantation. “We remove the kidney and move it as close as possible to the bladder, proceeding as in a conventional transplant”, explains the doctor, who relied on robotic assistance to perform this minimally invasive operation. “We had experience of robotic transplantation at the Toulouse University Hospital. But what is innovative in our gesture is the removal of the kidney, its rinsing – essential to avoid any toxicity – and the transplantation, all that belly closed with six small incisions.”
The day after the operation, the patient was able to walk again and she left the hospital three days later. “Initially, having my two kidneys functional didn’t matter. I didn’t want this nephrostomy anymore, that’s all. Today, looking back, I’m very happy. I don’t know what the future holds for me. reserve, I am therefore delighted to live with my two functional kidneys, I can continue my reconstruction”, rejoiced Charlotte.
For the medical team, this surgical prowess opens up new perspectives. “This example will allow us to think about new indications for robotic surgery such as the reconstruction of certain anatomical structures”, concludes Dr Nicolas Doumerc.
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