Open Kidney Transplantation Research Articles

A comparative study on outcomes of ABO-incompatible kidney transplants between robot-assisted vs. open surgery-propensity score-matched analysis: a retrospective cohort study.

Robot-assisted kidney transplantation (RAKT) is increasingly being adopted worldwide. Despite this growing interest, there remains a notable gap in the literature, especially concerning its effectiveness in immunologically high-risk patients compared to conventional open kidney transplantation (OKT). This study investigates the viability and success of RAKT in comparison with OKT, particularly for recipients with ABO incompatibility (ABOi). This retrospective, single-center study included 239 living-donor transplants between October 2020 and February 2023, with 210 patients undergoing ABOi-OKT and 29 undergoing ABOi-RAKT. A composite of biopsy-proven acute rejection (BPAR), graft failure, and the development of de novo donor-specific antibodies was analyzed through univariate and multivariate models. Propensity score matching (PSM) was utilized to ensure a balanced comparison between the two groups. Following PSM, a total of 131 cases in the OKT group and 26 cases in the RAKT group were analyzed. After PSM, the mean recipient age was 48.56 years for OKT and 47.96 years for RAKT. Both groups had comparable one-year (RAKT: 92.4%, OKT: 93.1%) and two-year BPAR-free survival rates (RAKT: 92.4%, OKT: 91.9%). Mean estimated glomerular filtration rate values were similar at 12 months post-transplant (RAKT: 62.15ml/min/1.73m², OKT: 64.53ml/min/1.73m²). Operative times were significantly longer for RAKT (291.42 vs. 150.81min, p < 0.001), while cold ischemic time was also longer for RAKT (119.77 vs. 47.22min, p < 0.001). Hospital stays were shorter for RAKT (median 6 vs. 8 days, p < 0.001). There was no significant difference in the composite outcome of BPAR, graft failure, and de novo donor-specific antibodies between the two groups (HR 0.858, 95% CI: 0.180-4.096, p = 0.848). RAKT is a safe and effective alternative to OKT in ABOi patients, demonstrating similar perioperative outcomes, graft survival rates, and renal function. The application of ropensity score matching analysis strengthens the reliability of these findings, confirming RAKT's viability for high-risk kidney transplant recipients. The clinical trial associated with this study was registered on 2024-02-24 with the Clinical Trial Number NCT06287008|| https://www. gov/ ).

Robot-assisted kidney transplantation: initial experience from a tertiary hospital in China

Abstract Background Robot-assisted kidney transplantation (RAKT) has currently become an effective alternative to open kidney transplantation (OKT), which has long been considered the gold standard for kidney transplant surgery. This study aimed to summarize our initial experience with RAKT and explore its safety and feasibility. Materials and methods Ten cases of RAKT, including 8 cases of deceased-donor kidney transplantation and 2 cases of living-donor kidney transplantation, were performed at our center from March 2023 to November 2023. Perioperative clinical data and follow-up results of patients were collected and statistically analyzed. Results All RAKT surgeries were performed successfully with no complications. The average operative time was 297.90 ± 65.59 minutes, and the median estimated blood loss was 100 mL. The average serum creatinine level decreased from 918.14 ± 166.63 μmol/L preoperatively to 109.89 ± 29.89 μmol/L at discharge. The postoperative outcomes of RAKT from both deceased and living donors were satisfactory during the follow-up period. Conclusions RAKT is an effective alternative to OKT and is suitable for both deceased- and living-donor kidney transplantations. The postoperative outcomes were satisfactory, and the postoperative complications were acceptable. RAKT appears to be a safe and feasible procedure for transplantation teams skilled in OKT and robot-assisted surgery.

Robot-assisted kidney transplantation: a propensity score-matched cohort analysis of early experience.

Kidney transplantation is the preferred treatment for patients with end-stage kidney disease. Since the introduction of robot-assisted kidney transplantation (RAKT), several centers have applied this technique as an alternative to open kidney transplantation (OKT). The objective of this study is to analyze our early experience, focusing on surgical technique and learning curve, and postoperative outcomes of RAKT. We retrospectively reviewed 782 living donor kidney transplantation recipients between January 2018 and January 2024. A propensity score-matched cohort of 50 RAKT and 150 OKT patients was evaluated for intraoperative and postoperative variables. Shewhart control charts and CUSUM analysis were used to evaluate technical outcomes and learning curves of RAKT. Postoperative eGFR values, complications, and biopsy results were compared for overall graft function and safety. RAKT patients were associated with significantly longer overall operative, rewarming, and anastomosis times. Although overall postoperative eGFR trends showed comparable graft function between RAKT and OKT recipients (51.35±2.64 vs. 54.01±1.45; P=0.315), RAKT patients with extremely long rewarming times exhibited aggravated chronic scores at 1 year protocol biopsies (Δ Chronicity Index = 4.45±1.92, P<0.001). CUSUM analysis of rewarming time revealed that proficiency in RAKT is achieved after approximately 15 cases. Despite longer anastomosis and ischemic times, even during the early stages of RAKT adoption, the RAKT group did not differ significantly in graft function or postoperative complications from the OKT group.

Comparison of Percutaneous Core Needle Biopsy Results in Patients Who Previously Underwent Open and Robot-Assisted Kidney Transplantation.

Objective: The objective of this study was to investigate the safety and efficacy of percutaneous graft biopsy, specifically in patients who have undergone robotic kidney transplantation, a topic that has received limited attention in the existing literature. While percutaneous graft biopsy is well established in patients who have undergone open transplantation, its application in robotic transplantation remains relatively unexplored. Material and Methods: A retrospective analysis was conducted on patient records spanning from 2013 to 2024, focusing on those who underwent graft biopsy due to acute graft dysfunction. The cohort was bifurcated into two distinct groups: individuals who underwent open kidney transplantation and those who underwent robotic kidney transplantation. Results: The study encompassed a total of 89 patients, with 64 having undergone open kidney transplantation and 25 having undergone robot-assisted kidney transplantation. The mean age of the patients was 40.61 (±12.26) years, with 60 (67.4%) being male and 29 (32.6%) being female. Comparative analysis revealed no significant disparities in age, gender distribution, body mass index, donor type (cadaveric versus living), or rates of graft loss between the two groups. Furthermore, examination of the total complication rates did not uncover any noteworthy differences between the cohorts. Conclusions: Ultrasound-assisted percutaneous needle biopsy is a reliable method in patients who have undergone robot-assisted kidney transplantation in cases of both indication-based and protocol biopsies. This study underscores the reliability of ultrasound-assisted percutaneous needle biopsy as a viable method for patients who have undergone robot-assisted kidney transplantation. By shedding light on the safety and efficacy of percutaneous graft biopsy in the context of robotic transplantation, this research contributes to the expanding body of knowledge in the field, providing valuable insights for clinical practice and future research endeavors.

Robot-assisted kidney transplantation-what is new?

The first robot-assisted kidney transplantation (RAKT) was conducted in 2010, and the first time in Germany in 2016. As more than 5years have passed, current evidence, technological developments and the latest (German) experience are presented. The current evidence and experience of RAKT was investigated from an international and German perspective. In asystemic search, relevant publications were analyzed and compared with the experiences at aGerman urological transplant department. From an international perspective, RAKT can now be considered astandard procedure at experienced departments, as more than 680 RAKT have been documented in Europe. The functional results are excellent with low complication rates and good mid- to long-term functional outcomes. Although RAKT was initially only performed with living organ donations, it has also been successfully conducted with cadaveric grafts. The surgical technique can be applied in challenging and complex situations, such as for arteriosclerotic recipient vessels or for kidney transplantations in children. Although RAKT is still not widely performed in Germany, the university hospital in Marburg, the third urological department in Germany, has successfully initiated arobotic transplant program. Compared to open kidney transplantation, robot-assisted kidney transplantation enables at least noninferior results. It further appears to translate the well-documented advantages of minimally invasive surgery to kidney transplantation. However, its spread throughout Germany is only slowly increasing, possibly because only ahandful of urological departments still perform kidney transplantations.

Current status and future perspectives on robot-assisted kidney autotransplantation: A literature review.

This review presents the latest insights on robot-assisted kidney autotransplantation (RAKAT). RAKAT is a minimally invasive surgical procedure and represents a promising alternative to conventional laparoscopic nephrectomy followed by open kidney transplantation for the treatment of various complex urological and vascular conditions. RAKAT can be performed either extracorporeally or intracorporeally. Additionally, a single-port approach can be performed through one small incision without the need to reposition the patient. Of 86 patients undergoing RAKAT, 8 (9.3%) developed postoperative > Grade 2 Clavien-Dindo (CD) complications. Although the feasibility of RAKAT was established in 2014, the long-term efficacy and safety along with outcomes of this surgical approach are still being evaluated, and additional studies are needed. With improvements in the technology of RAKAT and as surgeons gain more experience, RAKAT should become increasingly used and further refined, thereby leading to improved surgical outcomes and improved patients' quality of life.

Successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience.

Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. However, data on the feasibility and safety of performing RKT by surgeons with a lack of prior minimally invasive surgery (MIS) experience are limited. The authors aimed to evaluate the surgical and functional results of RKT and present the learning curves (LC) of RKT by a single surgeon with no prior experience in MIS. This was a retrospective study of all RKT performed between November 2019 and April 2023 at Severance Hospital in Seoul, South Korea. The authors analyzed surgical and functional outcomes, as well as complication rates of RKT in comparison to open kidney transplantation (OKT). The authors evaluated LCs using the cumulative summation method to describe the number of cases associated with the competency of a single surgeon. A total of 50 patients who underwent RKT and 104 patients who underwent OKT were included in this study. In RKT group, the median surgical console time was 193min (interquartile range, 172-222) and the median vascular anastomoses time was 38min (35-44). Total operation time was 323min (290-371) and rewarming time was 62.5min (56.0-70.0) in RKT group compared to 210min (190-239) and 25min (21-30), respectively, in OKT group. Despite extended surgical durations with a robotic technique, both groups had comparable intraoperative and postoperative outcomes, as well as renal function. Estimated blood loss and post-transplant hospital stays were significantly lower in RKT group than in OKT group. LC analysis of RKT by the single surgeon revealed that surgical competence was achieved after 15 cases. Even if surgeons do not have prior experience with MIS, they can rapidly overcome the LC and safely perform RKT with adequate preparation and acquisition of basic robotic surgical techniques.

Robot-assisted kidney transplantation in immunological high-risk patients: comparative analysis robot-assisted kidney transplantation versus open kidney transplantation

Robot-assisted kidney transplantation in immunological high-risk patients: comparative analysis robot-assisted kidney transplantation versus open kidney transplantation

Right versus left fully robotic live donor nephrectomy and open kidney transplantation: Does the laterality of the donor kidney really matter?

ObjectiveRobotic-assisted live donor nephrectomy (LDN) is being gradually adopted across transplant centers. The left donor kidney is preferred over right due to anatomical factors and ease of procurement. We aimed to study donor and recipient outcomes after robotic procurement and subsequent open implantation of right and left kidneys. MethodsAll fully robotic LDNs and their corresponding open kidney transplants performed at our center between February 2016 and December 2021 were retrospectively analyzed. ResultsOut of 196 robotic LDN (49 [right] vs. 147 [left]), 10 (5.1%) donors had intra-operative events (6.1% [right] vs. 4.8% [left], p=0.71). None of the LDN required conversion to open surgery. The operative times were comparable for the two groups. Nausea (13.3%) was the most common post-operative complication. There was no mortality in either LDN group. Herein, we report our outcomes on 156 recipients (39 right and 117 left allografts) excluding robotic implants, exports, and pediatric recipients. There were no significant differences between right and left kidney recipients with respect to 1-year post-transplant patient survival (100.0% vs. 98.1%, p=0.45) or graft survival (93.9% vs. 97.1%, p=0.11), or delayed graft function (7.7% vs. 5.1%, p=0.55). ConclusionNon-hand-assisted robotic live donor nephrectomies can be safely performed with excellent outcomes. Right LDN was not associated with higher incidence of complications compared to left LDN. Open implantation of robotically procured right renal allografts was not associated with higher risk of recipient complications.

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.

PD31-02 ROBOTIC ASSISTED KIDNEY TRANSPLANT STILL FAILING TO IMPRESS: A SYSTEMATIC REVIEW AND META-ANALYSIS

You have accessJournal of UrologyCME1 Apr 2023PD31-02 ROBOTIC ASSISTED KIDNEY TRANSPLANT STILL FAILING TO IMPRESS: A SYSTEMATIC REVIEW AND META-ANALYSIS Tuan Thanh Nguyen, Adnan El-Achkar, Berut Lebanon, Ho Yee Tiong, Ryan W. Dobbs, Huy Gia Vuong, Jacob Basilius, Le Quy Van Dinh, Ho Chi Minh, Vietnam, Jad Najdi, Trong Hieu Le, Tien-Dat Hoang, Khoa Quy, Ali Sohrab Naushad, Mohammed Shahait, Amman Jordan, and David I. Lee Tuan Thanh NguyenTuan Thanh Nguyen More articles by this author , Adnan El-AchkarAdnan El-Achkar More articles by this author , Berut LebanonBerut Lebanon More articles by this author , Ho Yee TiongHo Yee Tiong More articles by this author , Ryan W. DobbsRyan W. Dobbs More articles by this author , Huy Gia VuongHuy Gia Vuong More articles by this author , Jacob BasiliusJacob Basilius More articles by this author , Le Quy Van DinhLe Quy Van Dinh More articles by this author , Ho Chi MinhHo Chi Minh More articles by this author , Vietnam Vietnam More articles by this author , Jad NajdiJad Najdi More articles by this author , Trong Hieu LeTrong Hieu Le More articles by this author , Tien-Dat HoangTien-Dat Hoang More articles by this author , Khoa QuyKhoa Quy More articles by this author , Ali Sohrab NaushadAli Sohrab Naushad More articles by this author , Mohammed ShahaitMohammed Shahait More articles by this author , Amman JordanAmman Jordan More articles by this author , and David I. LeeDavid I. Lee More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003324.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Several centers have reported their recent experiences with the robotic approach in kidney transplantation. Previous reports suggest lower incidence of incisional hernia and lymphocele. However, these reported improvements in perioperative and follow-up outcomes are still debated. This most comprehensive and updated meta-analysis sought to compare the perioperative and follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT). METHODS: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until May 21, 2022. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). RESULTS: Of the 1580 retrieved abstracts, 95 underwent full-text review, and 15 studies were included in the final analysis, comprising a total cohort of 2,319 cases of kidney transplantation (667 RAKT and 1,652 OKT). The quality of the studies remains low with large heterogeneity in the cohorts. the RAKT group still has longer warm ischemia time, cold ischemia time, rewarming time, total ischemia time and operative time compared to the OKT group. Even though RAKT group had shorter incision length (RR=1.42, 95%CI (0.350 - 5.766), p=0.623) resulting in lower pain score (MD=-1.37, 95%CI (-1.59 - -1.15), p=<0.001), less morphine use (SMD=-3.478, 95%CI (-5.619 - -1.336), p=0.001), and shorter length of stay (LOS) (SMD=-0.496, 95%CI (-0.819 - -0.173), p=0.003), it has similar clinical estimated blood loss, similar rates of surgical site hernia and postoperative lymphocele. Both techniques have equivalent renal function, graft, and patient survival. Decrease surgical site infection remains only significant in obese patients. CONCLUSIONS: Our study showed that with a larger series and more patients, the initial promise that RAKT have lower rates rate of lymphocele incisional hernia is not true. While RKT does have shorter wound incision, less pain, and LOS, this comes at a cost of longer op times with no improvement in graft survival. The answer to whether RAKT is worthwhile remains to be answered by a randomized controlled study. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e900 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Tuan Thanh Nguyen More articles by this author Adnan El-Achkar More articles by this author Berut Lebanon More articles by this author Ho Yee Tiong More articles by this author Ryan W. Dobbs More articles by this author Huy Gia Vuong More articles by this author Jacob Basilius More articles by this author Le Quy Van Dinh More articles by this author Ho Chi Minh More articles by this author Vietnam More articles by this author Jad Najdi More articles by this author Trong Hieu Le More articles by this author Tien-Dat Hoang More articles by this author Khoa Quy More articles by this author Ali Sohrab Naushad More articles by this author Mohammed Shahait More articles by this author Amman Jordan More articles by this author David I. Lee More articles by this author Expand All Advertisement PDF downloadLoading ...

Robot-assisted kidney transplantation (RAKT) from deceased donors provides non-inferior perioperative and mid- term functional outcomes as compared to open kidney transplantation: A single-centre experience

Robot-assisted kidney transplantation (RAKT) from deceased donors provides non-inferior perioperative and mid- term functional outcomes as compared to open kidney transplantation: A single-centre experience

P8.034: Single Port Robotic Versus Open Kidney Transplantation: A Comparison of Outcomes

P8.034: Single Port Robotic Versus Open Kidney Transplantation: A Comparison of Outcomes

Three-dimensional Augmented Reality–guided Robotic-assisted Kidney Transplantation: Breaking the Limit of Atheromatic Plaques

BackgroundRobotic-assisted kidney transplantation (RAKT) has shown solid results as a minimally invasive alternative to the standard open approach (open kidney transplantation [OKT]). However, RAKT is still limited in those cases where the recipient’s iliac vessels present atherosclerotic plaques, frequently found in elder patients and in those subjected to long-term hemodialysis. Unlike OKT, where the surgeon can palpate the arterial plaques, in minimally invasive surgery the haptic feedback is missing, making the vascular clamping and arteriotomy unsafe. ObjectiveTo employ three-dimensional (3D) imaging reconstruction using augmented reality (AR) to intraoperatively locate the plaques during the crucial steps of kidney transplantation. Design, setting, and participantsOur study was conducted according to the Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) model for surgical innovation. Three-dimensional virtual models were obtained from high-accuracy computed tomography scan imaging and superimposed on the vessels during RAKT using the Da Vinci console software. Surgical procedureThree-dimensional AR–guided robotic-assisted kidney transplantation. MeasurementsThe correspondence of virtual models with the real anatomy of patients was assessed comparing vessels’ and plaques’ measures. Results and limitationsWe tested the possibility of using the AR in the setting of vascular surgery by checking the correspondence of the virtual models to the real vessels. During the accuracy assessment, we investigated the anatomy of the iliac plaques and the capacity of the virtual models to correctly represent them. Finally, we tested the efficacy of the virtual model superimposition on the real vessels with plaques during RAKT in the recipients of living donor grafts. The main limitation consists in training needed to correctly superimpose virtual models on the real field. ConclusionsThe employment of 3D AR allowed surgeons to overcome one of the main limitations of RAKT, setting the foundation to expand its indications to patients with advanced atheromatic vascular disease. Patient summaryThe use of three-dimensional augmented reality guidance during kidney transplantation (KT) has the potential to “navigate” the surgeon during KT, allowing a safer procedure in patients with atheromatic vascular disease.

Robot-assisted kidney transplantation: Is it getting ready for prime time?

Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint, KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery, especially due to its potential benefits for fragile and immunocompromised recipients. It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea, Development, Exploration, Assessment, Long-term follow-up recommendations for introducing surgical innovations into real-life practice. During the last years, mirroring the Vattikuti-Medanta technique, several centers developed RAKT program worldwide, providing strong evidence about the safety and the feasibility of this procedure. However, the majority of RAKT are still performed in the living donor setting, as an “eligible” procedure, while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation. In addition, despite the spread of minimally-invasive (predominantly robotic) surgery worldwide, many KTs are still performed in an open fashion. Regardless of the type of incision employed by surgeons, open KT may lead to non-negligible risks of wound complications, especially among obese patients. Particularly, the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications. In this context, robotic surgery could offer several benefits, including providing a better exposure of the surgical field and better instrument maneuverability, as well as the possibility to integrate other technological nuances, such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.

MP36-02 SINGLE PORT ROBOTIC VERSUS OPEN KIDNEY TRANSPLANTATION: A COMPARISON OF OUTCOMES

You have accessJournal of UrologyCME1 May 2022MP36-02 SINGLE PORT ROBOTIC VERSUS OPEN KIDNEY TRANSPLANTATION: A COMPARISON OF OUTCOMES Aaron Kaviani, Mohamed Eltemamy, Yi-Chia Lin, Mahmoud Abou Zeinab, Alp Tuna Beksac, Ethan Ferguson, Alvin Wee, and Jihad Kaouk Aaron KavianiAaron Kaviani More articles by this author , Mohamed EltemamyMohamed Eltemamy More articles by this author , Yi-Chia LinYi-Chia Lin 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 , Alvin WeeAlvin Wee More articles by this author , and Jihad KaoukJihad Kaouk More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002590.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We introduced the single-port robot-assisted kidney transplantation (KTP) using the da Vinci SP platform in 2019. Herein, we aimed to compare the perioperative and follow-up outcomes of the initial series of patients who underwent this procedure with the standard open KTP. METHODS: We compared a prospective cohort of 12 patients who underwent SP robotic KTP from Oct 2019 to Oct 2021 with a retrospective cohort of 12 matched patients who had open KTP at our institute. Patients were matched for donor type, the kidney donor profile index (KDPI) in deceased donors, recipient age, and history of diabetes. Perioperative data were retrieved from our institutional review board (IRB) approved database. Normality of data was tested with the Kolmogorov-Smirnov test when indicated. The comparison of normal data was performed using a T-test. Comparison of percentages was performed using the "N-1" Chi-squared test. RESULTS: Baseline characteristics and perioperative data of these patients are presented in Table 1. No patients in SP arm were converted to open surgery. Mean (SD) revascularization time in SP and open arms were 72.75 (11.93) and 36.25 (9.39) minutes respectively (P < 0.0001). There were no intra or postoperative complications greater than Clavien grade 2 in either group. The morphine milligram equivalents (MME) score during admission was 44.91 (40.15) in SP and 149.16 (119.70) in open groups (P = 0.0091). 6-, and 12-month graft and patient survival were 100% in both arms. There was no significant difference in mean creatinine level at 1, 6, and 12 months between SP vs. open group. There were no vascular or surgical complications during follow-up in either arm. CONCLUSIONS: Single port robotic kidney transplantation offers a minimally invasive approach with similar safety and allograft function compared to open kidney transplantation with the added benefit of less postoperative narcotics requirement. Larger series are required in this setting. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e596 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Aaron Kaviani More articles by this author Mohamed Eltemamy More articles by this author Yi-Chia Lin 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 Alvin Wee More articles by this author Jihad Kaouk More articles by this author Expand All Advertisement PDF DownloadLoading ...

V01-08 ROBOTIC ANASTOMOTIC STRICTURE REVISION OF THE TRANSPLANT KIDNEY: TECHNICAL CONSIDERATIONS AND OUTCOMES

You have accessJournal of UrologyCME1 May 2022V01-08 ROBOTIC ANASTOMOTIC STRICTURE REVISION OF THE TRANSPLANT KIDNEY: TECHNICAL CONSIDERATIONS AND OUTCOMES Felicia Balzano, and Boyd Viers Felicia BalzanoFelicia Balzano More articles by this author , and Boyd ViersBoyd Viers More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002520.08AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplantation is a widely performed procedure for patients with end stage renal disease. Urologic complications from the transplant kidney range from 3-30% with the incidence of ureteral stricture ranging from 1.9-3.7%. Of all complications that require surgical intervention, ureteral stricture accounts for 78% of them. We aim to discuss the technical considerations and present our outcomes after robotic anastomotic stricture revision in the transplanted kidney. METHODS: We retrospectively reviewed five patients who underwent open kidney transplantation with donor kidney who subsequently developed ureteral stricture and were treated with robotic repair with a single surgeon. All patients were confirmed to have ureteral stricture with preoperative antegrade nephrostogram. RESULTS: The average age of the patients was 54.4 years. 3 patients required ureteroureterostomy to native ureter, 1 required ureteroneocystostomy, and 1 required boari flap. The mean length of stay was 2 days. Average follow up was 326 days with no leaks identified. There were no wound infections or readmissions within 30 days. We had a 100% success rate in our cohort. CONCLUSIONS: By using an algorithmic approach with standardized evaluation, robotic repair of ureteral stricture in a transplant kidney can be done safely and effectively. Source of Funding: None © 2022 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 207Issue Supplement 5May 2022Page: e54 Advertisement Copyright & Permissions© 2022 by American Urological Association Education and Research, Inc.MetricsAuthor Information Felicia Balzano More articles by this author Boyd Viers More articles by this author Expand All Advertisement PDF DownloadLoading ...

Robotic-assisted Versus Open Technique for Living Donor Kidney Transplantation: A Comparison Using Propensity Score Matching for Intention to Treat.

Background.Living donor robotic-assisted kidney transplantation (RAKT) is an alternative to open kidney transplantation (OKT), but experience with this technique is limited in the United States.Methods.A retrospective review of living donor kidney transplants performed between 2016 and 2018 compared RAKT with OKT with regard to recipient, donor, and perioperative parameters. A 1:1 propensity score matching was performed on recipient/donor age, sex, body mass index, race, preoperative dialysis, and calculated panel reactive antibodies.Results.Outcomes of patient survival, graft survival, and postoperative complications were assessed for 139 transplants (47 RAKT and 92 OKT). Propensity score analysis (47:47) showed that RAKT recipients had longer warm ischemic times (49 versus 40 min; P < 0.001) and less blood loss (100 versus 150 mL; P = 0.005). Operative time and length of stay were similar between groups. Postoperative serum creatinine was similar during a 2-y follow-up. Post hoc analysis excluding 4 open conversions showed lower operative time with RAKT (297 versus 320 min; P = 0.04) and lower 30-d (4.7% versus 23.4%; P = 0.02) and 90-d (7% versus 27.7%; P = 0.01) Clavien-Dindo grade ≥3 complications.Conclusions.Our findings suggest that RAKT is a safe alternative to OKT.

Robotic Versus Open Kidney Transplantation from Deceased Donors: A Prospective Observational Study

BackgroundWhile robot-assisted kidney transplantation (RAKT) from living donors has been shown to achieve favourable outcomes, there is a lack of evidence on the safety and efficacy of RAKT as compared with the gold standard open kidney transplantation (OKT) in the setting of deceased donors, who represent the source of most grafts worldwide. ObjectiveTo compare the intraoperative, perioperative, and midterm outcomes of RAKT versus OKT from donors after brain death (DBDs). Design, setting, and participantsData from consecutive patients undergoing RAKT or OKT from DBDs at a single academic centre between October 2017 and December 2020 were prospectively collected. InterventionRAKT or OKT. Outcome measurements and statistical analysisThe primary outcomes were intraoperative adverse events, postoperative surgical complications, delayed graft function (DGF), and midterm functional outcomes. A multivariable logistic regression analysis assessed the independent predictors of DGF, trifecta, and suboptimal graft function (estimated glomerular filtration rate [eGFR] <45 ml/min/1.73 m2) at the last follow-up. Results and limitationsOverall, 138 patients were included (117 [84.7%] OKTs and 21 [15.3%] RAKTs). The yearly proportion of RAKT ranged between 10% and 18% during the study period. The OKT and RAKT cohorts were comparable regarding all graft-related characteristics, while they differed regarding a few donor- and recipient-related factors. The median second warm ischaemic time, ureterovesical anastomosis time, postoperative complication rate, and eGFR trajectories did not differ significantly between the groups. A higher proportion of patients undergoing OKT experienced DGF; yet, at a median follow-up of 31 mo (interquartile range 19–44), there was no difference between the groups regarding the dialysis-free and overall survival. At the multivariable analysis, donor- and/or recipient-related factors, but not the surgical approach, were independent predictors of DGF, trifecta, and suboptimal graft function at the last follow-up. The study is limited by its nonrandomised nature and the small sample size. ConclusionsOur study provides preliminary evidence supporting the noninferiority of RAKT from DBDs as compared with the gold standard OKT in carefully selected recipients. Patient summaryKidney transplantation using kidneys from deceased donors is still being performed with an open surgical approach in most transplant centres worldwide. In fact, no study has compared the outcomes of open and minimally invasive (robotic) kidney transplantation from deceased donors. In this study, we evaluated whether robotic kidney transplantation using grafts from deceased donors was not inferior to open kidney transplantation regarding the intraoperative, postoperative, and midterm functional outcomes. We found that, in experienced hands and provided that there was a time-efficient organisation of the transplantation pathway, robotic kidney transplantation from deceased donors was feasible and achieved noninferior outcomes as compared with open kidney transplantation.

Re: Robotic Kidney Transplantation with Regional Hypothermia Versus Open Kidney Transplantation for Patients with End Stage Renal Disease: An Ideal Stage 2B Study

Re: Robotic Kidney Transplantation with Regional Hypothermia Versus Open Kidney Transplantation for Patients with End Stage Renal Disease: An Ideal Stage 2B Study