Abstract

Renal autotransplantation (RAT) is a great surgical procedure for renal preservation, however it is underutilized due to its invasiveness. Robotic RATx has been in use since 2014. We conducted robotic RATx following a feasibility study using a porcine model. A 38-year-old woman with left ureteral stenosis was referred to us for urinary tract reconstruction. She had undergone an emergency Caesarean section for intraperitoneal bleeding secondary to left ovarian rupture four years earlier. After the surgery, she developed hypovolemic shock and disseminated intravascular coagulation (DIC) due to postoperative bleeding. Left internal iliac artery embolization saved her life. However, it resulted in a left ureteral stenosis measuring 2.7 cm that was located 5 cm from the left ureteral orifice, which required chronic ureteral stent exchange. Neither balloon dilation nor laser incision was successful. In addition, retrograde pyelography showed a possible left ureteropelvic junction obstruction. The patient was hesitant about the surgery because of its invasiveness. However, four years later, the patient elected to undergo robotic RATx. To date, only four cases of robotic RATx have been reported, including the current case. The indication of all four cases was extensive ureteral stenosis. Ileal ureter is frequently used for the treatment of extensive ureteral stenosis, but it can entail many problems including urine reabsorption resulting in metabolic acidosis. Ileal ureter is contraindicated for patients with a serum creatinine (sCr) level greater than 2 mg/dl. Even if sCr is less than 2 mg/dl, it is questionable whether sCr will remain less than 2 mg/ dl for the remainder of someone's life. Boari flap can give rise to vesicoureteral reflux causing urinary tract infection. RATx does not have those problems. Robotic RATx is a new, minimally invasive approach to renal preservation.

Original languageEnglish
Pages (from-to)314-320
Number of pages7
JournalNishinihon Journal of Urology
Volume81
Issue number3
Publication statusPublished - Jun 1 2019

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Robotics
Kidney Transplantation
Pathologic Constriction
Creatinine
Ureter
Kidney
Serum
Hemorrhage
Vesico-Ureteral Reflux
Autologous Transplantation
Urography
Disseminated Intravascular Coagulation
Iliac Artery
Feasibility Studies
Acidosis
Urinary Tract
Urinary Tract Infections
Cesarean Section
Stents
Rupture

Keywords

  • Kidney transplantation
  • Renal autotransplantation
  • Robotic surgery
  • Ureteral stenosis

ASJC Scopus subject areas

  • Urology

Cite this

Robotic renal auto transplantation. / Araki, Motoo; Wada, Koichiro; Nishimura, Shingo; Kubota, Risa; Kawamura, Kasumi; Maruyama, Yuki; Mitsui, Yosuke; Sadahira, Takuya; Takamoto, Atsushi; Sako, Tomoko; Edamura, Kohei; Kobayashi, Yasuyuki; Ishii, Ayano; Watanabe, Masami; Watanabe, Toyohiko; Nasu, Yasutomo.

In: Nishinihon Journal of Urology, Vol. 81, No. 3, 01.06.2019, p. 314-320.

Research output: Contribution to journalArticle

Araki M, Wada K, Nishimura S, Kubota R, Kawamura K, Maruyama Y et al. Robotic renal auto transplantation. Nishinihon Journal of Urology. 2019 Jun 1;81(3):314-320.
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