To treat his cancer, surgeons remove his kidney before transplanting it with a robot, a world first

the important thing
For the first time, an ablation of several cancerous tumors in a kidney was performed outside the body of a patient thanks to a procedure of self-transplantation through robotic surgery. The intervention took place at the University Hospital of Toulouse.

A 68-year-old patient, suffering from kidney cancer, benefited from an unprecedented operation at the University Hospital Center (CHU) in Toulouse last September. For the first time, Dr Nicolas Doumerc and Thomas Prudhomme, surgeons in the department of urology and kidney transplantation at Rangueil Hospital, removed three kidney tumors “outside the patient’s body” (“ex-vivo” in medical parlance ), on a table next to him, after removing the kidney through robotic surgery. Once the cancerous tumors have been removed, the kidney is self-transplanted in a robot-assisted manner, meaning it is re-implanted lower in the patient’s abdomen to repair the ureter damaged by previous treatments.

The whole of this sequence, in robot-assisted and minimally invasive surgery (an incision in the iliac fossa), allowed the patient to recover quickly, to keep his kidney and no more urine collection bag. (nephrostomy). “The goal really is to avoid the total removal of the kidney, to preserve the patient’s nephron capital. Of course, his cancer needs to be treated, but trying not to make his daily life more complicated in a nephrostomy (urine collection pocket , editor’s note). With tumors in both kidneys and risks of recurrence, it is important to take care of each kidney”, underlined Dr Nicolas Doumerc.

“Shows possible to treat cancer while preserving kidney function”

At the beginning of his treatment, in October 2021, the patient was treated with percutaneous thermo-ablation (heat source inserted into the skin) in interventional radiology to remove six tumors in the left kidney and four in the kidney. right The response in the right kidney was complete but there were still three tumors in the left kidney that were difficult to access. The thermal technique also damaged part of the ureter, the canal that connects the kidney to the bladder, requiring the placement of a pocket to divert urine. “We had two options: either we removed the stone completely, or we tried to remove the stone to treat it before reimplanting it in the healthy part of the ureter. Removing the stone by robotic surgery, we do it twice every week in the context of kidney transplants from a living donor, the removal of tumors is not complicated, and the reimplantation of the kidney in the way of a robot-assisted transplant, we also know how to do it very well . you just have to put everything together”, explains Dr Nicolas Doumerc.

The intervention was therefore not programmed to achieve the former. “In the end, my intern, Thomas Poirier, told me that it had never been done before. He checked by looking at the archive of medical publications and it was the first. We didn’t think of that but we have expertise throughout chain”, summarizes Dr Nicolas Doumerc. This work was published in the World Journal of Urology.

Three months after the intervention, the CT scan did not show any lesions or cancer recurrence. “This shows the value of preserving the kidney. It remains accessible, in case of recurrence, for radiological treatment. In kidney cancer, if there is only one kidney left, it is always more complicated to treat: in case of complications. , we go straight to kidney failure, which we know is a risk factor for mortality. without dialysis. In kidney cancer, we follow patients as for a chronic disease and we always juggling between different treatment strategies ( thermoablation or radiofrequency, cryotherapy, surgery)”, concluded the surgeon.

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