Laparoscopic Kidney Transplantation Research Articles

Does the Use of Mini-Incisions In Renal Transplantation Surgery Affect Postoperative Parameters: Single Center Experience

Kidney transplantation can be performed with different surgical approaches, such as conventional open kidney transplantation (CKT), minimally invasive kidney transplantation (MIKT), laparoscopic kidney transplantation, and robot-assisted kidney transplantation. Conventional open kidney transplantation is usually performed using a Gibson or hockey stick incision, may be associated with higher wound complication rates, and results in worse cosmetic outcomes compared with minimally invasive methods. Minimally invasive kidney transplantation is performed with a smaller skin incision than CKT but may result in limited surgical exposure. This study aimed to compare the surgical results of MIKT and CKT. Fifty-nine patients with a body mass index of 22 kg/m2 and below and with no anatomic variations in computed tomography were included in the study. Thirty-seven patients who underwent CKT were included in group 1, and twenty-two patients who underwent MIKT were included in group 2. Patient data were collected retrospectively. This study was conducted in compliance with The Helsinki Congress and The Declaration of Istanbul. The mean incision length was calculated as 12.7 cm in group 1 and 7.3 cm in group 2 (P < .05). There was no statistically significant difference between the groups in terms of lodge preparation time, vein clamp time, artery clamp time, ureteroneocystostomy time, visual analog scale scores, postoperative creatinine levels, or complication rates (P > .05 for each comparison). Without compromising the goals and primary concerns of transplantation surgery, MIKT can be offered to selected transplant patients with cosmetic concerns.

P8.046: Laparoscopic Kidney Transplantation: A Minimally Invasive Alternative for Our Country

P8.046: Laparoscopic Kidney Transplantation: A Minimally Invasive Alternative for Our Country

Extraperitoneal Laparoscopic Kidney Transplantation: Preliminary Clinical Experiences from China.

To report on the pioneering clinical experiences of six cases of extraperitoneal laparoscopic kidney transplantation in China. For the first time in clinical practice, a customised, controllable double-circulation cooling device was used to protect the transplanted kidney. Of the six patients, two underwent an allograft renal transplantation because they had been diagnosed with uraemia and were on maintenance haemodialysis. The other four patients underwent kidney autotransplantation because of a central renal tumour. The extraperitoneal laparoscopic kidney transplantations were successfully completed between 2017 and 2018. The operative time for the two patients undergoing the allograft transplantation was 3-3.5h. The time for venous anastomosis was approximately 53-65min, and the time for arterial anastomosis was approximately 25-30min. The creatinine level was 90-80μmol/L after surgery. The operative time of the four patients who underwent autotransplantation was 9.4-17.5h. The times of venous and arterial anastomosis were 58-90min and 35-48min, respectively. The follow-up B-mode ultrasound after surgery showed good blood supply in the spared nephron. A renal graft was removed from one patient 6months after surgery because of renal atrophy and dysfunction caused by poor blood supply. Five patients (two undergoing allografting and three undergoing autografting) completed the 12-month follow-up, and their renal graft function was good. Extraperitoneal laparoscopic kidney transplantation, either allograft or autologous transplantation, is a safe and feasible procedure with a good chance of survival for the transplanted kidney. A customised cooling device is effective and practical during laparoscopic kidney transplantation.

Robotic Assisted Dual Kidney Transplantation With Monolateral Iliac Vessels

To demonstrate the surgical technique of dual kidney transplantation in ipsilateral iliac fossa using da Vinci Si robotic platform METHODS: Dual kidneys from expanded criteria deceased donor were used in single recipients using robotic platform in 6 recipients. Following bench surgery, both kidneys were again placed into preservation fluid and ice-box. Robot was docked between 2 legs of the recipient. Common iliac and external iliac vessels on right side were dissected using robotic instruments. A 7 cm pfannenstiel incision was placed and one kidney was dropped into the abdomen; external aponeurosis was closed to restore the pneumoperitoneum. First kidney vascular anastomosis was done with common iliac vessels. Second kidney was introduced through the same wound and transplanted with external iliac vessels. Both ureters were implanted separately into the bladder. Between January 2013 and December 2017, 6 patients had dual robotic-assisted laparoscopic kidney transplantation. All procedures were carried out successfully without conversion to open operation. Mean time for venous anastomosis, arterial anastomosis and total operation were 16.4 (10-19) minutes, 17.5 (13-24) minutes, and 359.1 (265-500) minutes. Mean blood loss was 188.3 (80-300) ml. Two patients had delayed graft function. One patient expired 3 months following transplant due to pneumonia. Using 7 cm Pfannenstiel incision, dual robotic-assisted laparoscopic kidney transplantation with common iliac and external iliac vessels is technically feasible.

Outcomes of Kidney Transplantation by Laparoscopic Surgery versus Open Surgery

Introduction Laparoscopic surgery for live donor nephrectomy has become the standard of care due to multiple benefits. This has also facilitated an increase in the live donor pool. Over last few years, laparoscopic surgery for kidney transplantation has been explored with promising results. However, concerns have been raised as to whether there is any additional predisposition to damage to the kidney graft due to prolonged time for vessel anastomosis during learning period. Therefore, the aims of this study are to investigate the outcomes of kidney transplantation by laparoscopic surgery in comparison with open surgery in a large animal model. Materials and Methods The study was approved by the Animal Ethics Committee of the institute. Eleven large white female pigs, weighing about 40 kg were selected for this study. The model of orthotopic auto transplantation was employed in this study with transplantation performed by laparoscopic surgery in six pigs (LG), and open surgery in five pigs (OG). The technique of laparoscopic kidney transplantation has been described previously with 5 ports and a small ventral midline incision (6-8 cm). The open surgery was performed by a large flank incision about 18 cm in length. The pigs recovered from surgery and were monitored for 4 weeks. Body temperature was monitoredKidney graft temperature was monitored during vessel anastomosis. A kidney biopsy was taken prior to kidney procurement and kidney implantation, immediately post implantation and at the end of study. The time for vessel anastomoses was recordedBlood tests of haemoglobin (Hb) and creatinine (Cr) were done for assessment of the kidney function. Outcomes All surgeries were performed successfully. The recovery in 7 pigs was uneventful, while 2 pigs in each group required early euthanasia during the recovery period. The venous anastomotic time was similar in both groups, although the renal artery anastomosis was longer in LG (P<0.05). Body temperature was stable during the surgery.Kidney temperature rapidly increased to ~20°C and then slowly increased until completion of vessel anastomosis.The Hb level was stable pre and post surgery in both groups. The peak Cr level was on day 1 and returned to pre-operative levels by day 7. The Cr level was significantly higher in OG on day 1 and day 3 post-transplant, then returned close to normal level from day 7 and remained stable until the end of study. Histopathology of the biopsy was similar in both groups with very mild change. The incision was significantly smaller in LG than OG Conclusion The recovery of kidney graft function after transplantation was comparable between the two groups.The Kidney graft temperature increased rapidly, then remained steady.There is no specific damage seen on histopathology in the kidney graft that was transplanted by laparoscopic surgery. The major advantage of laparoscopic surgery over open surgery is a minimally invasive with a smaller incision.

Outcome of Robotic Assisted Laparoscopic Kidney Transplantation with and Without Regional Hypothermia

Introduction During vascular anastomosis the kidney graft slowly gain temperature and becomes warm. Regional hypothermia is shown to be effective to reduce rewarming of the kidney during robotic assisted laparoscopic kidney transplantation (RKT). Currently there is no study available to compare impact of regional hypothermia versus no hypothermia during RKT. Here we present data of RKT with and without regional hypothermia. Material and methods RKT was carried out in 100 patients; the first 50 cases had regional hypothermia and later 50 cases did not have hypothermia. Regional hypothermia was created by introducing 250-300 ml of ice slush around the kidney before carrying out vascular anastomosis. Body surface warming was carried out in all cases of regional hypothermia. Living donor kidney with single renal artery and vein was used in all cases. Results No case was converted to open operation. Longer anastomosis time and operative time in initial 50 cases represents learning curve of RKT.No delayed graft function was observed in any case and graft function was measured in terms of serum creatinine. (Figure-1). At 3 years there was no difference in graft and patient survival in either group (Figure-2a and 2b). Three patients in regional hypothermia group developed severe systemic hypothermia (temp. 94 degree F) and needed extubation in intensive care unit 6-12 hours after completion of surgery. Conclusion Regional hypothermia using ice slush may be useful during learning of RKT; however, once anastomosis time is reduced to less than 40 minutes, outcome of RKT without reginal hypothermia are similar to RKT with regional hypothermia. Severe systemic hypothermia may occur and intra-operative warming is required in patients subjected to regional hypothermia.

V36 - Laparoscopic kidney transplantation with transvaginal insertion of allograft kidney

V36 - Laparoscopic kidney transplantation with transvaginal insertion of allograft kidney

ROBOTIC-ASSISTED KIDNEY TRANSPLANTATION: A REVIEW

Objective: To discuss about kidney transplantation (KT), primarily on robotic-assisted kidney transplantation (RAKT) and to present the current updates on RAKT techniques performed by different centres worldwide. Material &amp; methods: We searched and compiled various literatures on RAKT, focussing on different techniques used to perform the procedure. All the references cited in this review are indexed in PubMed or Scopus. Results: Since the first successful kidney allograft transplantation in human was performed in 1954, KT has become the preferred treatment modality for patients with end-stage renal disease (ESRD) seeking a more definitive outcome and better quality of life. Over the years, newer techniques of KT have been introduced, including minimally-invasive laparoscopic KT. However, laparoscopic KT has its own limitations, which include loss of hand-eye coordination and poor ergonomics for the surgeon. RAKT offers the same benefits as laparoscopic KT without its limitations. There are several transplantation centres worldwide performing RAKT regularly. The differences in RAKT technique between these centres are regarding patient’s position during surgery, location of incision for graft placement, use of regional hypothermia, and techniques of graft placement and ureteric reimplantation. Conclusion: The invention of RAKT as a minimally-invasive KT technique has enabled surgeon to perform surgeries when the operative field is deep and narrow and when fine dissection and microsuturing are required.

Tailored Integrated Training for Robotic Assisted Laparoscopic Kidney Transplantation

Tailored Integrated Training for Robotic Assisted Laparoscopic Kidney Transplantation

Robotic Kidney Transplantation-an Update.

Over the last decade, there have been advances in kidney transplantation with introduction of minimally invasive surgery. Robotic surgery is becoming increasingly common across the specialities. There is now increasing experience in robotic kidney transplantation, though it remains a niche procedure. Initial reports suggest that this is a safe, feasible operation when performed by teams familiar with robotic surgery. There have been a few modifications to the initially described procedure, as a result of increasing experience. There is no significant difference in graft and patient survival when compared with open surgery and laparoscopic kidney transplantation. It is a safe procedure and therefore represents a viable alternative to open surgery in selected patients particularly the obese. The advantages include less postoperative pain and fewer wound complications such as surgical site infections and hernia, which could be particularly advantageous in the obese. Robotic kidney transplantation is procedure that has been developed over the last decade and could have applicability in kidney transplantation in the obese. Its main benefit is in enabling surgery in less accessible spaces due to body habitus, combined with those of using a smaller incision with less associated morbidity, with no inferiority in the reported primary outcomes of graft and patient survival. There are capital costs associated with this procedure, but further studies on the cost-effectiveness of robotic kidney transplantation are needed before it can be adopted widely.

V09 - First laparoscopic kidney transplantation in Turkey

V09 - First laparoscopic kidney transplantation in Turkey

Laparoscopic orthotopic kidney transplantation and laparoscopic pancreas transplantation: Initial research with a pig model

Laparoscopic orthotopic kidney transplantation and laparoscopic pancreas transplantation: Initial research with a pig model

Laparoscopic Transplantation Following Transvaginal Insertion of the Kidney: Description of Technique and Outcome

Laparoscopic kidney transplantation (LKT) is well accepted modality of treatment for ESRD patients at our center. Usually, the kidney is inserted through small Pfannenstiel incision. With the permission of the Internal Review Board, we carried out LKT in eight female recipients following insertion of the kidney through the vagina. The kidney was procured by the retroperitoneoscopic approach. Antibiotic prophylaxis was given. All cases were carried out successfully with immediate graft function and 100% graft and patient survival at 1 year of follow-up. Estimated glomerular filtration rate at 1 month and 1 year was similar to eight randomly selected female recipients who underwent open kidney transplantation (OKT). No analgesia was required in seven out of eight patients after the 3rd postoperative day. In summary, vaginal insertion of kidney and LKT is safe and feasible in a selected group of patients. It is associated with better analgesia and has similar allograft function as compare to OKT.

Laparoscopic Kidney Transplant by Extra Peritoneal Approach: The Safe Transition From Laboratory to the Clinic

The aim of this study is to develop a novel laparoscopic surgery by extra-peritoneal approach for kidney transplant and pave the way of safe transition from laboratory to the clinic. The study was established to explore the feasibility and safety of human laparoscopic kidney transplant. The experiment was first conducted on the deceased animals, then live animals and human cavader before human kidney transplant was approved. The study patient was a 49-year-old male who received the kidney for laparoscopic kidney transplant by extra-peritoneal approach. The control patient received the contralateral kidney for open kidney transplant. The estimated blood loss was minimal during surgery. Both kidneys experienced delayed graft function but the kidneys started function on Day 6 postoperation. The analgesia consumption was significantly less in the study patient. There is no surgical complication during 6-month follow-up. This study has developed a new technique for laparoscopic kidney transplant by extra-peritoneal approach. It has retained the advantages of open kidney transplant, which allows the graft located in the extra-peritoneal space without violating peritoneum. This study has also paved the way of safe transition for a novel laparoscopic surgery from laboratory to the clinic.

Vaginal Insertion of Kidney and Laparoscopic Kidney Transplantation: An Initial Experience.

Introduction: Minimally invasive surgery (MIS) for kidney transplantations are performed either by small incision during open surgery, laparoscopically or robotically. Following MIS, specimen retrieval through vagina is well known. Following laparoscopic or robotic assisted living donor nephrectomy kidney retrieval through vagina are reported. Here we present our initial experience of insertion of kidney through vagina and laparoscopic kidney transplantation (LKT). Material and methods: Permission of IRB was obtained. Major inclusion criteria were at least one normal vaginal delivery and good capacity of vagina on examination. Exclusion criteria were active vaginal infection or atrophic vagina. Antibiotic prophylaxis was used. Total 8 transplants carried out. Recipient surgery: In 20 degree Trendelenbergh position five ports are placed. External iliac vessels were dissected. Subsequently, lithotomy postion was given and gynecologist manipulated uterus and vagina. Laparoscopically incision in posterior fornix of vagina was made and kidney was inserted into abdomen. Posterior fornix was closed and vagina packed. Both legs were straightened and pneumoperitoneum was restrored. Kidney was brought close to iliac vessels. Laparoscopic free hand vascular anastomosis and ureteric reimplantation was performed. Results: Mean time for cold ischemia, anastomosis, re-warming, and operation was 103 min., 40 min., 59.5 min., 255 min. respectively. No DGF. No infection. One year graft and patient survival is 100%. Conclusion: Vaginal insertion of kidney and laparoscopic kidney transplantation are safe and effective. Larger studies are required for confirmation of these findings

Laparoscopic Kidney Transplant By Extra Peritoneal Approach: A Model for Safe Transition From Laboratory to the Clinic.

Laparoscopic Kidney Transplant By Extra Peritoneal Approach: A Model for Safe Transition From Laboratory to the Clinic.

Vaginal Insertion of Kidney and Robotic Assisted Laparoscopic Kidney Transplantation: The First World Experience.

Introduction: Following laparoscopic or robotic assisted living donor nephrectomy kidney retrieval through vagina are reported. Here we present our initial experience of insertion of kidney through vagina and robotic assisted laparoscopic kidney transplantation (RKT). Material and methods: Permission of IRB was obtained. Major inclusion criteria were at least one normal vaginal delivery and good capacity of vagina on examination. Exclusion criteria were active vaginal infection or atrophic vagina. Antibiotic prophylaxis was used. Total 3 transplants carried out. Recipient surgery: In 30 degree Trendelenberg and Lithotomy position six ports were placed; one camera port, three robotic ports, one assistant port and one port for suction and irrigation. External iliac vessels were dissected. Robot was undocked. Gynecologist placed an incision in posterior fornix of vagina and kidney was inserted into abdomen. Wound of posterior fornix was closed and vagina packed. Robot was re-docked and kidney brought close to previously dissected external iliac vessels. Vascular anastomosis was carried out by Gore Tex CV6 suture. Ureteric reimplantation was performed using 4/0 vicryl without stent. Results: There was no injury to kidney parenchyma, no delayed graft function and no infection. Mean anastomosis time, rewarming time and blood loss were 51 min., 72 min., 67.5 ml respectively. Six months graft and patient survival is 100%. Conclusion: Vaginal insertion of kidney and RKT is feasible and safe. Larger studies are required for confirmation of these findings.

Robotic Assisted Laparoscopic Kidney Transplantation: Experience of First 46 Cases.

Robotic Assisted Laparoscopic Kidney Transplantation: Experience of First 46 Cases.

Robotic Assisted Laparoscopic Kidney Transplantation in Children-An Initial Experience.

Robotic Assisted Laparoscopic Kidney Transplantation in Children-An Initial Experience.

A Human Cadaver Model For Laparoscopic Kidney Transplant

To evaluate the technique of laparoscopic kidney transplant and demonstrate the feasibility of this procedure by an extraperitoneal approach. The procedure was performed on 2 human cadavers. Retroperitoneal endoscopic left nephrectomy was performed. An extraperitoneal space was established by inflation of a balloon dilator. The external iliac artery and vein were exposed. A Pfannenstiel incision (6 cm) was made and a hand-access device was used. The renal artery was anastomosed to the external iliac artery (end-to-side anastomosis); the renal vein was anastomosed to the external iliac vein (end-to-side anastomosis). The ureter was anastomosed to the bladder with an extravesical tunnelling technique. The donor kidney grafts were obtained successfully. The preparation of the external iliac artery and vein was satisfactory. The entire procedure for the renal artery, renal vein, and ureteral anastomoses was performed with laparoscopic technique without any difficulty. The present model on human cadavers may provide a feasible approach for training surgeons to perform human laparoscopic kidney transplant. The present technique may be applied to clinical human kidney transplant.