Safety and efficacy of video assisted thoracoscopic surgery for non-malignant pathologies: a prospective observational study

Background: Video-assisted thoracic surgery (VATS) had been widely accepted because of its low complication rate, tolerable postoperative pain and early recovery of pulmonary function. Hence the present study was undertaken to assess safety and efficacy of VATS and also analyze the surgical outcomes of VATS procedures for non-malignant thoracic pathologies.Methods: A total of 32 patients with non-malignant pathologies of thorax to undergo VATS lobectomy and thoracotomy conversion cases initially approached by VATS lobectomy were enrolled. Demographic data and surgical information were noted and compare between infection and non-infection group. Primary outcomes were thoracotomy conversion rate, period of thoracic drainage, length of hospital stay, and complications.Results: The majority of patients were in the age group of 36-45 years (28.12%) with female predominance (62.50%). The commonest clinical presentation was hydropneumothorax (28.12%). Most common infective and non-infective aetiology was lung hydatid (28.12%) and benign nodule (18.75%) respectively. The commonest surgical procedures conducted using VATS were lobectomy (34.37%), and decortication (25%). The mean blood loss among the cases was 315.9±36.46 ml. Mean operative time was 157.18±12.37 minutes. Among 6.25% cases thoracotomy was conducted in view of difficult hilar dissection, while among 3.12% cases each of indistinct anatomy and bleeding. Mean duration of thoracic drainage was 6.78±1.69 days and mean hospital stay was 8.2±3.2 days. 6.25% cases had fatal complications while 21.87% cases had milder complications. Only one case recurred while 96.87% cases cured.Conclusions: VATS lobectomy for benign disease is feasible and effective in selected cases, regardless of the presence of infection.

Management of a Donor Supernumerary Kidney During Renal Transplantation: A Case Report

Introduction: A fused hilar supernumerary kidney was discovered in a donor organ upon reperfusion during renal transplantation. There is a paucity of literature regarding this anomaly and its management in renal transplant recipients. Case Presentation: Back table preparation of a right deceased donor kidney revealed a duplicated renal artery and ureter. Complex reconstruction of the vasculature was performed avoiding extensive hilar dissection. Following anastomosis of the renal vasculature to the recipient’s iliac vessels, reperfusion revealed a suspicious lower pole renal mass. Frozen section biopsies of the mass were consistent with normal renal parenchyma. Urology was consulted intraoperatively and confirmed the mass to be a small accessory kidney with a separate collecting system, thin parenchyma and hydroureteronephrosis. A nephrectomy of the supernumerary kidney was performed. Discussion: Supernumerary kidneys are extremely rare and infrequently encountered by transplant surgeons. They are usually asymptomatic and incidentally discovered on imaging. If discovered intraoperatively careful inspection must be performed to evaluate for stigmata of potential complications. Conclusion: Knowledge of this entity is important to provide crucial intraoperative decision making and management if encountered in a donor organ. Careful evaluation of these anomalies must be performed when considering resection in order to avoid later complications, with caution that resection may compromise renal function.

The Anatomy of Renal Arteries in Adults

Detailed extraparenhymal renal hilar dissection was performed on 110 fixed cadaveric kidneys (60 from male cadavers and 50 from female cadavers). We analyzed the number of renal arteries, angles between renal arteries and abdominal aorta, length and diameter of the renal arteries. Multiple renal arteries were present in 20.9% of cases, with a slightly higher incidence on the right side (21.8%: 20.0%). The angle between the aorta and the RRA varied from 30° to 100° with a mean of 64.1°, while the angle between the abdominal aorta and the LRA was 40° to 115°, with a mean of 67.3°. The external caliber of the RRA at the point of origin from the abdominal aorta was 5 mm to 9.1 mm, with a mean of 6.8 mm. The same caliber of the LRA was 3.7 to 9.6 mm with a mean of 7.0 mm. The average length of the renal artery from the point of origin from the abdominal aorta to the branching point was 36.2 mm for the right renal artery and 30.7 mm for the left renal artery. The average length of the renal artery from the point of origin from the abdominal aorta to the renal hilum was 65.1 mm for the right one and 54.7 mm for the left one. Knowledge of the number of renal arteries, their mode of entry into the kidney, the angles they build with the abdominal aorta, their diameter and length has practical applications in interventional radiology and surgery of the kidney and its environment.