CU 21. Novel therapy for complicated renal artery aneurysm: Retroperitoneal laparoscopic nephrectomy and ex vivo repair with minimally invasive autotransplantation

Objective: To explore the safety, effectiveness and feasibility of retroperitoneal laparoscopic nephrectomy, ex vivo aneurysmectomy, renal revascularization and minimally invasive heterotopic renal autotransplantation in the treatment of complicated renal aneurysm.

Methods: The data of one male patient with complicated renal artery aneurysm (RAA) treated in Dec. 2010 were analyzed retrospectively, and documents regarding the diagnosis and therapy were reviewed. The preoperative color Doppler ultrasonograph, CT and CTA showed that there was an aneurysm (4.5 cm × 4.0 cm × 3.0 cm) located in the main renal artery bifurcation and its six branches of the right kidney. After successful retroperitoneal laparoscopic nephrectomy, the kidney off-body was perfused with 4 oC renal irrigatingsolution immediately to protect the kidney. Then ex vivo aneurysmectomy and renal artery revascularization with autoallergic great saphenous vein were performed. The reconstructed right kidney was re-implanted into the right iliac fossa via the incision of removal kidney from retroperitoneal cavity with minimally invasive procedure.

Results: The operative procedure was finished in 6.5 hours successfully, with renal warm ischemia time of 4 min and cold ischemia time of 2.5 hours, and the blood lost of 50 mL. The patient recovered without perioperative complications. The postoperative renal function was normal, and the color Doppler ultrasonograph in 2 weeks and CTA in 1 month post operation showed that the shape of the transferred kidney was normal, the blood circulation in the transferred renal artery and vein and its branches was smooth, with no stenosis, and the ureter was not obstructive.

Conclusions: The iconography is the main method to diagnose RAA, and the surgery is the principal way to manage RAA. The procedures of retroperitoneal laparoscopic nephrectomy, ex vivo aneurysmectomy, renal revascularization and minimally invasive heterotopic renal autotransplantation are safe, effective, feasible and minimally invasive to treat complex RAA.