[First experience of 3D-laparoscopy in donor nephrectomy]. / Nachal'nyi opyt ispol'zovaniya 3D-videosistem pri laparoskopicheskoi donorskoi nefrektomii.

OBJECTIVE: To assess the first experience of 3D imaging for laparoscopic donor nephrectomy. MATERIAL AND METHODS: The study included 28 laparoscopic donor nephrectomies and 28 subsequent transplantations to related recipients. Of these, 14 laparoscopic donor nephrectomies were performed using 3D camera. The main intraoperative parameters and information about postoperative period in donors and recipients were compared with similar data on previous laparoscopic donor nephrectomies and kidney transplantations with traditional 2D imaging. There were 15 left-sided and 13 right-sided nephrectomies. Twenty and eight laparoscopic nephrectomies were performed via retroperitoneal and transperitoneal access, respectively. There were no significant between-group differences in age, sex ratio, BMI, side of surgery and number of renal arteries. RESULTS: Surgery time (119.28±9.18 and 124.85±7.49 min, respectively) and blood loss (106.78±16.12 and 119.28±19.79 ml, respectively) were similar. Laparoscopic nephrectomy with 3D imaging was followed by significantly shorter primary warm ischemia (2.41±0.79 and 3.23±0.57 min, respectively, p=0.004) and time of extracorporeal preparation of the transplant (back table) under cold preservation (27.21±5.42 and 32.36±5.33 min, respectively, p=0.02). CONCLUSION: Initial experience of video systems with 3D imaging in laparoscopic donor nephrectomy has not yet led to significant reduction of surgery time and improvement of transplant function compared to traditional 2D imaging. At the same time, there was a shorter period of primary warm ischemia and back table time. Further analysis is needed to assess possible benefits of 3D imaging in laparoscopic donor nephrectomy.

Is Kidney Transplantation From a COVID-19-Positive Deceased Donor Safe for the Recipient?

INTRODUCTION: In recent months, the number of kidney transplants from deceased donors has declined significantly. One of the reasons is the possibility of infection of the recipient with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Determining the risk of transmission of coronavirus disease 2019 (COVID-19) with a donor organ is very important for developing a kidney transplantation policy during a pandemic. MATERIALS AND METHOD: We present cases of kidney transplantation from COVID-19-positive deceased donors to 2 dialysis patients 49 and 45 years old. One of them was on hemodialysis for 28 months; the other received continuous ambulatory peritoneal dialysis (CAPD). Both patients received only basic immunosuppression, including tacrolimus, methylprednisolone, and mycophenolic acid. No antilymphocyte agents were used for induction therapy. RESULTS: Cold ischemia time was 22 and 21 hours, respectively. One recipient had delayed graft function with increasing of urine output on day 8; another had immediate function. Both patients had no febrile and no other symptoms of acute respiratory disease during their hospital stay. No abnormalities on the chest x-ray were seen. No serum anti-SARS-CoV-2 IgM and IgG were detected before and during 6 weeks after surgery. Repeated nasopharyngeal swabs real-time reverse transcription polymerase chain reaction (rRT-PCR) were negative during the period. Both recipients were discharged 5 weeks after surgery with serum creatinine levels of 122 and 91 mcmol/L, respectively. CONCLUSION: Today we have no evidence of the possibility of transmission of COVID-19 from a SARS-CoV-2 positive donor to a kidney recipient. We also have no reason to suspect kidney damage by COVID-19 in a deceased donor at normal serum creatinine level.

[Left-sided renal cell cacrinoma with vena cava inferior thrombus: totally laparoscopic removal].

A surgical treatment of patients with tumor thrombus in the inferior vena cava (IVC) of levels II-III, originating from the left renal vein involves performing thrombectomy, radical nephrectomy and lymph nodes dissection. In most cases it requires major open surgery which leads to complications in 38% of patients and perioperative mortality of 4-10%. In recent years, the laparoscopic radical nephrectomy with thrombectomy have been gradually introduced. However, there are anecdotal reports about performing of such interventions in case of left-sided renal tumor with thrombus in the IVC. A description of technique and own experience of performing laparoscopic radical nephrectomy with thrombectomy from the IVC in 3 patients with tumor thrombus of levels II-III, originating from left kidney are presented. In one case distant metastases were detected preoperatively and in another patient an involvement of tail of the pancreas by the tumor was diagnosed. There was no conversion to open surgery. The maximum tumor size ranged from 5 to 16 cm. The length of tumor thrombus in the IVC was 2.4-7 cm and estimated blood loss was 300-2500 ml. In one case a blood transfusion was required postoperatively. The follow-up period was 4-26 months. One patient died from progression of the disease after 5 months, two other patients are alive without any signs of relapse. The initial experience of laparoscopic radical nephrectomy with thrombectomy from IVC in patients with left-sided renal cell cancer suggests that this technique is reproducible and relatively safe with respecting of basic principles of oncology and vascular surgery. The surgery is not associated with major perioperative complications, significant blood loss and is accompanied by a rather favorable postoperative period. An accumulation of a larger number of cases is needed to assess the oncological results of this technique.

[Retroperitoneoscopic radical nephrectomy with inferior vena cava thrombectomy].

INTRODUCTION: Although laparoscopic radical nephrectomy has confidently established itself as the "gold standard" for treating renal cell carcinoma, reports on laparoscopic level II-III inferior vena cava (IVC) tumor thrombus thrombectomy are still lacking. MATERIALS AND METHODS: From September 2013 through April 2015, three patients with renal cell carcinoma and level II IVC tumor thrombi underwent laparoscopic radical nephrectomy with IVC thrombectomy using a retroperitoneal approach. Tumor sized 10, 8, and 9 cm in the greatest dimension, the length of the IVC thrombi in proximal direction were 2.8, 4.1 and 3.5 cm, respectively. RESULTS: In all patients, the endoscopic interventions were completed successfully without conversion to open surgery. Blood loss was less than 450 ml. No significant intraoperative or postoperative complications were observed. The patients were discharged from the hospital in satisfactory condition at days 19, 7 and 14, respectively. One patient with multiple lung and bone metastases died 11 months after the operation. The two other patients showed no signs of disease progression during the follow-up (16 and 35 months). CONCLUSION: The retroperitoneal approach has certain advantages over the transperitoneal one. The method is relatively safe and reproducible. However, additional experience and further research are needed before the place of such operations in routine clinical practice can be assessed.