Laparoscopic Transplant Nephrectomy Using a Combination of Intracapsular and Extracapsular Approaches for Graft Intolerance Syndrome in Failed Renal Allografts.

IF 0.5 Q4 Medicine

IJU Case Reports Pub Date : 2026-07-26 eCollection Date: 2026-07-01 DOI:10.1002/iju5.70237

Yuto Naroda, Atsuhiko Ochi, Ryutaro Fukagai, Maiko Shimogawa, Masatoshi Matsunami, Jun Yashima, Tomo Suzuki, Yu Oyama, Hirokazu Abe, Masayoshi Okumi

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Abstract

Introduction: Transplant nephrectomy for graft intolerance syndrome is technically challenging because severe perirenal adhesions increase bleeding risk. Despite the increasing adoption of minimally invasive techniques, optimal laparoscopic strategies remain limited.

Case presentation: A 49-year-old man developed pembrolizumab-induced graft intolerance syndrome (GIS) following surgery for native renal cell carcinoma. To enable safe continuation of immunotherapy, laparoscopic transplant nephrectomy was performed. Despite severe adhesions, a combined intracapsular and extracapsular approach enabled safe graft removal. Multiple feeding vessels were divided using a vessel-sealing device and soft coagulation, while avoiding extensive hilar dissection. Postoperative computed tomography confirmed complete resection of the allograph, with no radiologically evident residual tissue or postoperative complications.

Conclusion: This hybrid laparoscopic approach is a safe, minimally invasive option for managing GIS with severe adhesions.

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腹腔镜移植肾切除术采用囊内和囊外联合入路治疗同种异体肾移植失败的移植物不耐受综合征。

移植肾切除术治疗移植物不耐受综合征在技术上具有挑战性，因为严重的肾周粘连会增加出血的风险。尽管越来越多的采用微创技术，最佳的腹腔镜策略仍然有限。病例介绍：一名49岁男性在接受原生肾细胞癌手术后出现派姆单抗诱导的移植物不耐受综合征（GIS）。为了保证免疫治疗的安全继续进行，我们进行了腹腔镜肾移植切除术。尽管有严重的粘连，但囊内和囊外联合入路可以安全切除移植物。在避免广泛肝门剥离的同时，采用血管密封装置和软凝对多条供血血管进行分流。术后计算机断层扫描证实同种异体完全切除，无放射学上明显的残余组织或术后并发症。结论：这种混合腹腔镜入路是治疗严重粘连的GIS的一种安全、微创的选择。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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