Efficacy and utility of robotic single-access bilateral nephrectomy (r-SABN) in end-stage renal disease patients.

Abstract

Bilateral native nephrectomies are needed in ESRD patients with select indications in a pre-transplant setting. Yet, the perioperative morbidity is significant in this population. Herein we evaluate the efficacy and utility of r-SABN. A total of 12 patients were consented at a single center. Of 12 patients, 3 patients did not meet study criteria and were excluded. Preoperative, perioperative, and postoperative data were prospectively collected from 9 patients from electronic health records and administered postoperative surveys. Patients were assessed at 30-180days postoperatively for follow-up. Mean operative time was 204.3 ± 59.7min (142.0-314.0) and estimated blood loss during operation was 94.4 ± 87.3ml (25.0-300.0). The mean length of hospital stay was 2 ± 0.7days (1-3) for all patients. Total post-operative opioid usage was normalized to morphine dose equivalents (MDE) and calculated to be 56.1 ± 30.4mg (30.8-101.8). Patients experienced a fourfold and tenfold respective increase in weekly structural and incidental physical activity from 30 to 180days postoperatively. There were no procedure related intraoperative or postoperative complications reported in the cohort. Overall, r-SABN afforded the patients low morbidity. Longitudinal studies are in progress to further assess the efficacy and outcome of this procedure. In a single-center study, we demonstrate r-SABN is viable and provides a novel tool for treatment of ESRD patients requiring this procedure.