A surgical team from Toulouse University Hospital extracted and transplanted a kidney vaginally using a surgical robot. Doctors relate this world first.
Toulouse University Hospital is revolutionizing kidney transplantation. Surgeons extracted and transplanted a kidney from a living donor vaginally assisted by a surgical robot. This world first is a major step forward towards less invasive surgery.
To do this, two steps were necessary. The premiere took place in May 2015 (1). Two surgeons, Drs Nicolas Doumerc, expert in robot-assisted urological surgery, and Federico Sallusto, coordinator-responsible for renal transmission at the Toulouse University Hospital, performed a robotic renal transplant via the vagina on a first patient.
“And then we said to ourselves why not give the donor benefit? », Tells Why actor Dr Nicolas Doumerc. On the morning of July 9, the team then removed and transplanted a kidney using a surgical robot vaginally in two sisters. “An all-robot sequence unique in the world”, rejoices the specialist.
Nicolas Doumerc, expert in robot-assisted urological surgery: “ It is a surgery where there is no room for error because a kidney is removed from a patient who is not at all sick. But in this case, it was necessary that all our innovative gestures do not cause the patient to lose benefits, and that is what was the most difficult. “
5 holes of 8 millimeters
Like traditional laparoscopy, the use of a surgical robot makes it possible to make 5 small incisions of less than one centimeter in the belly. But despite the use of this technique, these interventions require an incision the size of the kidney (a dozen centimeters) in the belly. This is why these specialists thought of removing and introducing the organ through the vagina.
“When we transplant a kidney to a patient with renal failure, we are not removing the native kidneys. We place the graft in the small pelvis in the iliac fossa on the iliac vessels (not far from the uterus and the bladder, editor’s note) so we do not go back to the kidneys, ”says the surgeon.
However, going through the vagina presents several difficulties. The first concerns the size of the incision which must be adequate for that of the kidney. Thanks to the images of the scanner, the surgeons were able to measure very precisely that an incision of 8 centimeters would be enough to pass the kidney.
“The second is the potential bacterial contamination of the vagina. Above all, the kidney should not come into contact with the vaginal walls, explains Dr Nicolas Doumerc. We solved this problem, on the one hand by placing the graft in a plastic bag, and on the other hand, by using a plastic retractor with gel, which allowed us to reduce the risk of traumatizing the graft. “
Credit: Toulouse Hospitals. Dr Nicolas Doumerc (back) directs the robot’s articulated instruments from a distance
Quick and less painful recovery
The donor was able to return home two days after the operation, and her sister after 4 days of hospitalization. Several weeks after the operation, the two women are doing very well with hardly any noticeable scars. In addition to a reduced length of stay and few scars, the use of the Da Vinci robot also allows a faster recovery, reducing post-operative pain and the risk of infection.
Around the world, around a hundred patients have benefited from robotic surgery as part of kidney transplantation, mainly in the United States, India and France since 2001 at the Henri-Mondor hospital in Créteil, then at the CHU de Tours twelve years later.
Nicolas doumerc : ” This technique in men could be of interest for obese patients in whom normal kidney surgery is very complicated. The robotic tool can allow us to make a small incision of a few centimeters to enter the kidney at the level of the navel. “
But this cutting-edge area is not just reserved for kidney transplants. In October 2013, in France, more than 80 Da Vinci robots were in service, according to the National Agency for the Safety of Medicines and Health Products (ANSM). Mainly used in urology to operate on prostate or kidney cancer, the robot is also used in gynecological or even cardiac surgery. In total, since 2011, more than 17,000 interventions have been carried out.
(1) In May, Dr Nicolas Doumerc was assisted by Dr Mathieu Roumiguié, and in July by Dr Jean-Baptiste Beauval.
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-1730888646.jpg "Kidney donation while alive: “It was an act of love that I did for my sister”")
