V05-02 SINGLE PORT ROBOT-ASSISTED EXTRAPERITONEAL KIDNEY TRANSPLANTATION: TIPS AND TRICKS

Abstract

You have accessJournal of UrologyCME1 May 2022V05-02 SINGLE PORT ROBOT-ASSISTED EXTRAPERITONEAL KIDNEY TRANSPLANTATION: TIPS AND TRICKS Aaron Kaviani, Jihad Kaouk, Mahmoud Abou Zeinab, Alp Tuna Beksac, Ethan Ferguson, Yi-Chia Lin, Alvin Wee, and Mohamed Eltemamy Aaron KavianiAaron Kaviani More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Alp Tuna BeksacAlp Tuna Beksac More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , Alvin WeeAlvin Wee More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002579.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Multiport transperitoneal robot-assisted kidney transplant is performed in few centers across the globe. We introduced the single-port robot-assisted extraperitoneal kidney transplantation using the da Vinci SP platform (Intuitive Surgical, Sunnyvale, CA USA) in 2019. In this video, we aimed to provide detailed tips and tricks for the surgical steps of this approach. METHODS: Thirteen patients underwent single-port robot-assisted kidney transplantation. The patients are placed in the supine position with the bed slightly flexed, tilted toward the left side, and put in a 15° Trendelenburg position. A 5-cm infraumbilical incision is made. The extraperitoneal space is developed. The robot is docked per the floating docking technique. The external iliac artery and vein are dissected off lymphatics. Benching of the kidney is performed. LigaSure device (Medtronic, Dublin, Ireland) is used to dissect the vessels. The posterior surface of the artery and the vein are marked for better intracorporal orientation. A 14 cm ureteral stent is placed. A 3-0 chromic suture is placed in the lower pole for nephropexy. Kidney is wrapped with a blue glove with cut-off fingers covering the lower pole. A 12 mm port is placed through the same incision and 400 mL of ice is introduced. The kidney is then introduced. The venous and arterial anastomoses are performed using 6-0 GORE-TEX® sutures (Gore Medical, Flagstaff, AZ, USA). An 8-inch suture is used for each anastomosis and it is tied on itself at the distal and proximal corners. Bulldog clamps (Scanlan, Saint Paul, MN, USA) are used for vascular control. Arteriotomy is made using a sleeve-protected scalpel. Aortic punch is introduced directly through the abdominal wall. After completion of the anastomosis, the kidney is repositioned to the space above the psoas muscle. Ureteroneocystostomy is performed using 4-0 Vicryl sutures. The kidney is fixed to the lateral abdominal wall. The robot is undocked and the wound is closed. RESULTS: Surgery was successfully completed in all patients without conversion to open surgery or adding extra ports. There were no intra or postoperative complications greater than Clavien grade 2. There was no delayed graft function. Median (IQR) vein and artery anastomosis times were 26 (24-28) and 37 (33-40) minutes. Patients stayed in the hospital for 2–3 days. Mean (SD) creatinine at 6 and 12 months were 1.31 (0.24) and 1.30 (0.16) mg/dL. CONCLUSIONS: We demonstrated detailed tips and tricks for steps of the single-port robot-assisted extraperitoneal kidney transplantation. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e516 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Kaviani More articles by this author Jihad Kaouk More articles by this author Mahmoud Abou Zeinab More articles by this author Alp Tuna Beksac More articles by this author Ethan Ferguson More articles by this author Yi-Chia Lin More articles by this author Alvin Wee More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF DownloadLoading ...