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Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation

View Article: PubMed Central - PubMed

ABSTRACT

On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.

No MeSH data available.


Techniques for living kidney donation in combined laparoscopic surgery. A – Proper placement of trocars, B – kidney removal in EndoBag through vagina
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Figure 0002: Techniques for living kidney donation in combined laparoscopic surgery. A – Proper placement of trocars, B – kidney removal in EndoBag through vagina

Mentions: Robotic transplantation is a fairly recent development, employed in cases where there is a high risk of surgical site infections or when patients are morbidly obese, therapeutic effects being noted. Despite the fact that such innovations have been in use for a relatively short time, it has had a very dynamic effect, with positive results. A notable recent development in kidney transplantation surgery came in 2012 when Galvani et al. performed a single-incision robotic-assisted living donor nephrectomy. Another is when Kaouk et al. became the first group to perform a transvaginal hybrid natural orifice transluminal surgery robotic donor nephrectomy (Figure 2) [49–52]. More importantly, though, such revolutionary developments are seen by many as key to overcoming the obstacles posed by the small number of donors and organs which exist at present. Minimally invasive and associated with fewer complications, an increasing number of therapy units are offering this method of kidney transplantation, theoretically enabling more transplants in general and the possible growth of domino and cross transplants. In turn, a greater volume of living donors may be attracted to this “softer” form of kidney donation, with better cosmetic results and fewer potentially negative consequences compared to standard open and laparoscopic nephrectomies [53–55]. Other factors which indicate the growth of robotic systems in kidney transplantations are that it facilitates access to treatment for morbidly obese patients previously denied it as well as the development of innovative telemedicine procedures, where there is hope that transplants can be performed at distance [56–58].


Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation
Techniques for living kidney donation in combined laparoscopic surgery. A – Proper placement of trocars, B – kidney removal in EndoBag through vagina
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC5016594&req=5

Figure 0002: Techniques for living kidney donation in combined laparoscopic surgery. A – Proper placement of trocars, B – kidney removal in EndoBag through vagina
Mentions: Robotic transplantation is a fairly recent development, employed in cases where there is a high risk of surgical site infections or when patients are morbidly obese, therapeutic effects being noted. Despite the fact that such innovations have been in use for a relatively short time, it has had a very dynamic effect, with positive results. A notable recent development in kidney transplantation surgery came in 2012 when Galvani et al. performed a single-incision robotic-assisted living donor nephrectomy. Another is when Kaouk et al. became the first group to perform a transvaginal hybrid natural orifice transluminal surgery robotic donor nephrectomy (Figure 2) [49–52]. More importantly, though, such revolutionary developments are seen by many as key to overcoming the obstacles posed by the small number of donors and organs which exist at present. Minimally invasive and associated with fewer complications, an increasing number of therapy units are offering this method of kidney transplantation, theoretically enabling more transplants in general and the possible growth of domino and cross transplants. In turn, a greater volume of living donors may be attracted to this “softer” form of kidney donation, with better cosmetic results and fewer potentially negative consequences compared to standard open and laparoscopic nephrectomies [53–55]. Other factors which indicate the growth of robotic systems in kidney transplantations are that it facilitates access to treatment for morbidly obese patients previously denied it as well as the development of innovative telemedicine procedures, where there is hope that transplants can be performed at distance [56–58].

View Article: PubMed Central - PubMed

ABSTRACT

On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.

No MeSH data available.