Health: “ex-vivo” removal of multiple and complex kidney tumors carried out using robotic surgery

The Toulouse University Hospital announced on January 4 a technical feat: the “ex-vivo” (outside the body) removal of tumors on a kidney, followed by kidney self-transplantation with repair of the ureter. A 68-year-old patient benefited from this innovative intervention which allowed her to keep her kidney and return to a normal life. It was performed by Doctor Nicolas Doumerc, urological surgeon in the Department of Urology, Andrology and Renal Transplantation, Rangueil Hospital – Toulouse University Hospital, assisted by the urology surgical team. This innovation was the subject of a publication in the Word Journal of Urology in November 2022.

Robotic surgery is a real technological advance in patient care. Thanks to it, operations are less invasive, postoperative risks and infections are reduced and the patient recovers faster than after conventional surgery.

Since September 2009, the Rangueil hospital (CHU Toulouse) has had the surgical robot ” da Vinci If HD®” which allows surgeons to perform certain complex and delicate surgical procedures, in a less invasive way, thanks to small incisions. A year ago, it strengthened its multidisciplinary surgical technical platform with the commissioning of the latest generation surgical robot ” da Vinci Xi®”.

Nicolas Doumerc, who is a urologist surgeon there, performs most of his operations with this robot. In 2015, he also performed a world first: a totally robotic kidney transplant, without incision, with passage through the vagina. His expertise has allowed him to train other practitioners in France and Europe in robotic surgery.

“Ex-vivo” removal of a kidney: a new first for Nicolas Doumerc

In October 2021, a scanner had diagnosed in a patient 6 cancerous tumors, of low aggressiveness, on the left kidney and 4 on the right kidney. She was treated in interventional radiology for percutaneous thermal ablation of both kidneys: ablation of the tumors by a heat source introduced through the skin.

The control subsequently carried out by scanner and MRI showed that the tumors had disappeared on the right kidney, while on the left kidney, for reasons of accessibility, only three tumors out of six could be treated. In addition, the ureter, very close to one of the tumours, had been damaged (thermal injury) making diversion of urine through the skin (nephrostomy) necessary.

As the three untreated tumors continued to expand, the surgical team proposed an innovative technique: extract the kidney and remove the three tumors hitherto inaccessible on the “back table”, i.e. on a table next to the patient.

The kidney was then reimplanted in the lower abdomen, connected to the iliac artery and the ureter reimplanted in a healthy area.

Robotic assistance enabled minimally invasive surgery where conventional surgery would have been cumbersome and risky. It made it possible to treat the tumor cells while preserving the kidney, avoided permanent disability for the patient who would have had to live with a permanent nephrostomy and thus opens up new possibilities in the treatment of multiple and complex lesions of the kidney.

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Health: “ex-vivo” removal of multiple and complex kidney tumors carried out using robotic surgery

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