Vaginal Insertion of Kidney and Laparoscopic Kidney Transplantation: An Initial Experience.

Abstract

Introduction: Minimally invasive surgery (MIS) for kidney transplantations are performed either by small incision during open surgery, laparoscopically or robotically. Following MIS, specimen retrieval through vagina is well known. Following laparoscopic or robotic assisted living donor nephrectomy kidney retrieval through vagina are reported. Here we present our initial experience of insertion of kidney through vagina and laparoscopic kidney transplantation (LKT). Material and methods: Permission of IRB was obtained. Major inclusion criteria were at least one normal vaginal delivery and good capacity of vagina on examination. Exclusion criteria were active vaginal infection or atrophic vagina. Antibiotic prophylaxis was used. Total 8 transplants carried out. Recipient surgery: In 20 degree Trendelenbergh position five ports are placed. External iliac vessels were dissected. Subsequently, lithotomy postion was given and gynecologist manipulated uterus and vagina. Laparoscopically incision in posterior fornix of vagina was made and kidney was inserted into abdomen. Posterior fornix was closed and vagina packed. Both legs were straightened and pneumoperitoneum was restrored. Kidney was brought close to iliac vessels. Laparoscopic free hand vascular anastomosis and ureteric reimplantation was performed. Results: Mean time for cold ischemia, anastomosis, re-warming, and operation was 103 min., 40 min., 59.5 min., 255 min. respectively. No DGF. No infection. One year graft and patient survival is 100%. Conclusion: Vaginal insertion of kidney and laparoscopic kidney transplantation are safe and effective. Larger studies are required for confirmation of these findings