Background: Nephrectomy with autotransplantation (NAT) has been performed as an alternative treatment for complex renovascular lesions, intricate ureteral strictures and nephron-sparing surgery in complex renal tumors. Methods: A retrospective observational study was conducted including patients who underwent a NAT from January 2010 to September 2023. Data collected included surgery indications, surgical technique, complications according to Clavien–Dindo classification and mean hospital stay. Descriptive and inferential statistical analysis was performed using IBM^® SPSS^® Statistics version 28.0.1.0. Results: A total of 34 consecutive patients underwent 38 NATs at our institution. Surgery indications were complex renovascular conditions in 35 cases (92.1%), of which 24 had renal artery aneurysms, and ureteral injuries in 3 cases (7.9%). Thirty-four kidneys (89.5%) were retrieved through a laparoscopic approach. No significant difference was observed between post- and pre-operative creatinine levels (0.81 vs. 0.72, p = 0.303). Early high-grade complications developed in 12 procedures (31.6%). Median cold ischemia time was significantly longer in patients who developed complications (163.0 vs. 115.0, p = 0.010). The median hospital stay was 10 days (8–13). The median follow-up was 51.5 months. Conclusions: NAT emerges as a successful therapeutic strategy for a highly select group of patients dealing with intricate ureteral lesions and kidney vascular abnormalities, demonstrating positive outcomes that endure in the long term.

Introduction: The first human pure natural orifice translumenal endoscopic surgery nephrectomy was recently described,¹ but being technically challenging, its use in clinical practice at present is precluded. Hybrid procedures associating abdominal and natural orifice access can overcome such issues.² We present our initial series of transvaginal-assisted laparoscopic nephrectomy. Materials and Methods: Between January and March 2010, women found to have nonfunctioning kidney were submitted to transvaginal-assisted laparoscopic nephrectomy in a single tertiary center. The video depicts a left nephrectomy: two abdominal ports (5 and 10 mm) were used to carry out the procedure as usual in laparoscopic nephrectomy; image was provided by a deflectable optic inserted through an extra-long 12-mm trocar placed transvaginally; a third abdominal port for liver retraction was used in right nephrectomy; the intact specimen was retrieved through the vagina. Patient characteristics and intra- and postoperative data were prospectively accrued; descriptive statistics (median, range) are reported. Results and Conclusions: Five nephrectomies were performed (two right and three left nephrectomies). Patient characteristics were as follows: age 53 (38–57), American Society of Anesthesiologists (ASA) physical status score 2 (1–2), body mass index 25.6 (23.1–30); two were previously hysterectomized. Operative time was 155 min (125–195), estimated blood loss 50 cc (50–250), and no intra- or postoperative complications occurred after a median follow-up of 2 months (1–3). Visual analog pain scale in the first 24 h was 1/10 (0–2) and analgesia discontinued thereafter; patients were discharged on postoperative day 2 (2–3). Transvaginal-assisted laparoscopic nephrectomy is feasible and safe; it reduces the number of abdominal ports and allows retrieval of the intact specimen with minimal scar, potentially reducing pain and need for analgesics. The authors have nothing to disclose. Runtime of video: 7 mins 24 secs Note: This video was accepted for presentation at the 28th World Congress of Endourology and SWL.