Robotic-assisted Laparoscopic Donor Nephrectomy Research Articles

Introducing robot‐assisted laparoscopic donor nephrectomy after experience in retroperitoneal endoscopic approach: a matched propensity score analysis

To assess the safety and efficacy of introducing robotic-assisted laparoscopic donor nephrectomy (RALDN) to the standard retroperitoneal endoscopic donor nephrectomy (REDN). Data were collected prospectively from 124 consecutive living kidney donors (93 for REDN subgroup and 31 for RALDN subgroup) from February 2018 to December 2020. Donor baseline demographics, perioperative outcomes and recipient outcomes were recorded, and these parameters were compared between the two subgroups before and after propensity-score matching. Mean age was 51.1 ± 9.1 years; 42.7% were males; mean body mass index was 22.7 ± 2.4; and there were 109 (88%) left kidneys. The following data of REDN and RALDN was, respectively, recorded: operative time (213 ± 43 versus 216 ± 39 min, p=0.721), warm ischemic time (4.7 ± 1.2 versus 4.9 ± 1.4 min, p=0.399), postoperative complications (5.4% versus 6.5%, p=1), haemoglobin (g/L) drop (9.4 ± 7.2 versus 9.7 ± 6.6, p=0.836), blood creatinine at 6 month (1.15 ± 0.23 versus 1.13 ± 0.24 mg/dL, p=0.734) and at 1 year (1.09 ± 0.22 versus 1.17 ± 0.28 mg/dL, p=0.591). In post-propensity score matched analyses, there was no significant differences between the two groups including intraoperative and postoperative complications. RALDN could be safely introduced into a living donor program experienced in laparoscopic donor nephrectomy. The outcomes of our study comparing these minimally invasive techniques are mostly similar in terms of intraoperative and postoperative outcomes for kidney donors.

Effect of learning curve on the perioperative course of robotic-assisted laparoscopic donor nephrectomy compared with laparoscopic donor nephrectomy.

This study was designed to compare the standard and robotic-assisted laparoscopic donor nephrectomy in terms of perioperative course, short-term postoperative outcome, and to evaluate the effect of surgeon's learning curve on these parameters. This was a prospective randomized study including 60 patients (mean age, 47 years; age, 21-72 years; 26 males, 34 females) who had been planned laparoscopic donor nephrectomies in our clinic. For comparison of standard and robot-assisted techniques and to evaluate the impact of learning curve, patients were randomized into three groups by a computer, each group containing 20 patients. Group 1: standard laparoscopic donor nephrectomies; Group 2: the first 20 patients who underwent robot-assisted laparoscopic donor nephrectomy; and Group 3: the next 20 patients who underwent robot-assisted laparoscopic donor nephrectomy. Operative time was significantly higher in Group 2 (221.0±45.1 min) than both Group 1 (183.5±16.9 min, p=0.001) and Group 3 (186.5±20.6 min, p=0.002). Similarly, time for laparoscopic system setup was significantly higher in Group 2 (39.5±8.6 min), which contained the first cases of robot-assisted laparoscopic donor nephrectomy where surgeon had least experience than Group 1 (19.3±3.7 min, p<0.001) and Group 3 (24.0±9.4 min, p<0.001). On the other hand, duration of operation and time for laparoscopic system setup was similar between Groups 1 and 3. Learning curve extends the operative time and laparoscopic system setup time in robotic-assisted laparoscopic donor nephrectomy, however, after the learning process was completed, these parameters were similar between robotic-assisted and standard laparoscopic nephrectomy.

ROBOTIC VERSUS LAPAROSCOPIC LIVING DONOR NEPHRECTOMY: A PROSPECTIVE STUDY

Introduction: Robotic-assisted laparoscopic donor nephrectomy (RALDN) reportedly facilitate better hilar dissection but had associated concerns regarding longer graft retrieval and ischemia times. The aim of this study is to assess safety and efficacy of an initially introduced RALDN when compared to the routine retroperitoneal laparoscopic living donor nephrectomy (RLLDN) at a single institution transplant program. Materials and Methods: Data were collected prospectively from 64 consecutive living kidney donors (12 for RALDN subgroup and 52 RLLDN subgroup) at our hospital from May 2018 to August 2019. All donors were approved by our Government Hospital Renal Transplantation Council according to Amsterdam Guidelines. Patient demographics, radiology findings, surgery results and complications were recorded. Primary endpoints were peri-operative parameters, postoperative outcomes and complications. The surgeons were experienced retroperitoneoscopic using three ports and robotic surgeons using the Da Vinci Si System with three arm robotic ports. Results: For the entire group, mean age ± SD was 51.7 ± 8.9 years, and 58% were females. Mean BMI was 22.5 ± 2.3 (15.6 - 27.3). There were 54 (84%) left kidneys. Preoperatively, there were no significant differences between the two patient groups including age, gender, BMI, kidney side, hilar anatomy and ASA status. For perioperative outcomes, there was no significant differences (P>0.05) comparing RALDN and RLLDN respectively for warm ischemic time (4.75 ± 1.54vs. 4.75 ± 1.38 minutes), operative time (233 ± 46 vs. 216 ± 41 minutes), hemoglobin (g/L) drop (9 ± 5.6 vs. 8.6 ± 7.2), postoperative complications (All Clavien) (16.7% vs. 9.6%), the donor blood creatinine at one month (1.1 ± 0.2 vs. 1.2 ± 0.3 mg/dL), and the recipient blood creatinine at one month (1.2 ± 0.3 vs. 1.4 ± 0.4 mg/dL). There were no open conversions or delayed graft functions in both groups. Conclusion: This study showed that RALDN can be safely introduced into living donor program experienced in laparoscopic donor nephrectomy. This allows the program to utilize the operative advantages including better optics and instrument dexterity of the platform in all or selected cases.

Donor and Recipient Outcomes following Robotic-Assisted Laparoscopic Living Donor Nephrectomy: A Systematic Review.

Aims We aimed to summarize available lines of evidence about intraoperative and postoperative donor outcomes following robotic-assisted laparoscopic donor nephrectomy (RALDN) as well as outcomes of graft and recipients. MethodsA systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2018. The following search terms were combined: nephrectomy, robotic, and living donor. We included full papers that met the following criteria: original research; English language; human studies; enrolling patients undergoing RALDN. Results Eighteen studies involving 910 patients were included in the final analysis. Mean overall operative and warm ischemia times ranged from 139 to 306 minutes and from 1.5 to 5.8 minutes, respectively. Mean estimated blood loss varied from 30 to 146 mL and the incidence of intraoperative complications ranged from 0% to 6.7%. Conversion rate varied from 0% to 5%. The mean hospital length of stay varied from 1 to 5.8 days and incidence of early postoperative complications varied from 0% to 15.7%. No donor mortality was observed. The incidence of delayed graft function was reported in 7 cases. The one- and 10-year graft loss rates were 1% and 22%, respectively. ConclusionsBased on preliminary data, RALDN appears as a safe and effective procedure.

Robotic kidney autotransplantation in a porcine model: a procedure-specific training platform for the simulation of robotic intracorporeal vascular anastomosis.

Robotic-assisted kidney transplantation (RKT) with the Da Vinci (Intuitive, USA) platform has been recently developed to improve outcomes by decreasing surgical site complications and morbidity, especially in obese patients. This potential paradigm shift in the surgical technique of kidney transplantation is performed in only a few centers. For wider adoption of this high stake complex operation, we aimed to develop a procedure-specific simulation platform in a porcine model for the training of robotic intracorporeal vascular anastomosis and evaluating vascular anastomoses patency. This paper describes the requirements and steps developed for the above training purpose. Over a series of four animal ethics' approved experiments, the technique of robotic-assisted laparoscopic autotransplantation of the kidney was developed in Amsterdam live pigs (60-70kg). The surgery was based around the vascular anastomosis technique described by Menon et al. This non-survival porcine training model is targeted at transplant surgeons with robotic surgery experience. Under general anesthesia, each pig was placed in lateral decubitus position with the placement of one robotic camera port, two robotic 8mm ports and one assistant port. Robotic docking over the pig posteriorly was performed. The training platform involved the following procedural steps. First, ipsilateral iliac vessel dissection was performed. Second, robotic-assisted laparoscopic donor nephrectomy was performed with in situ perfusion of the kidney with cold Hartmann's solution prior to complete division of the hilar vessels, ureter and kidney mobilization. Thirdly, the kidney was either kept in situ for orthotopic autotransplantation or mobilized to the pelvis and orientated for the vascular anastomosis, which was performed end to end or end to side after vessel loop clamping of the iliac vessels, respectively, using 6/0 Gore-Tex sutures. Following autotransplantation and release of vessel loops, perfusion of the graft was assessed using intraoperative indocyanine green imaging and monitoring urine output after unclamping. This training platform demonstrates adequate face and content validity. With practice, arterial anastomotic time could be improved, showing its construct validity. This porcine training model can be useful in providing training for robotic intracorporeal vascular anastomosis and may facilitate confident translation into a transplant human recipient.

V8-04 ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC LIVING DONOR NEPHRECTOMY: A 12-STEP COMPARISON OF SURGICAL TECHNIQUE

You have accessJournal of UrologyBladder Oncology/Testis/Transplantation/Trauma1 Apr 2016V8-04 ROBOTIC-ASSISTED VERSUS LAPAROSCOPIC LIVING DONOR NEPHRECTOMY: A 12-STEP COMPARISON OF SURGICAL TECHNIQUE Michael Palese, Jamie Pak, Edward Chin, Greg Gin, Daniel Herron, Susan Lerner, Dianne LaPointe Rudow, Antonios Arvelakis, Scott Ames, Alan Benvenisty, Ron Shapiro, and Sander Florman Michael PaleseMichael Palese More articles by this author , Jamie PakJamie Pak More articles by this author , Edward ChinEdward Chin More articles by this author , Greg GinGreg Gin More articles by this author , Daniel HerronDaniel Herron More articles by this author , Susan LernerSusan Lerner More articles by this author , Dianne LaPointe RudowDianne LaPointe Rudow More articles by this author , Antonios ArvelakisAntonios Arvelakis More articles by this author , Scott AmesScott Ames More articles by this author , Alan BenvenistyAlan Benvenisty More articles by this author , Ron ShapiroRon Shapiro More articles by this author , and Sander FlormanSander Florman More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2016.02.747AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Laparoscopic donor nephrectomy (LDN) has gained wide acceptance among surgeons and donors due to better short-term donor morbidity compared to the open approach without compromising graft outcome. The first robotic-assisted laparoscopic donor nephrectomy (RDN) was reported in 2002. A recent randomized comparative study reported less postoperative pain, less analgesic requirement, and shorter hospital stay with RDN versus LDN. In this video, we compare the operative technique of RDN vs. LDN at our institution at twelve critical steps of the procedure. METHODS The 12 steps include: 1. Medial reflection of descending colon, 2. Complete mobilization of spleen, 3. Exposure of gonadal vessel and renal vein, 4. Ligation of adrenal, gonadal, and lumbar veins, 5. Mobilization of kidney laterally and posteriorly, 6. Dissection of adrenal off upper pole/superior mobilization, 7. Dissection of renal hilum, 8. Medial rotation of kidney along hilum and posterior hilar dissection, 9. Mobilization and ligation of distal ureter, 10. Preparation for extraction, 11. Ligation of renal artery and vein, and 12. Extraction of kidney. Our case series of RDN were then compared to our historical institutional LDN case series as previously reported in a 2009 manuscript. RESULTS LDN utilizes fenestrated forceps in the left hand and Harmonic Ace shears in the right, while RDN utilizes bipolar precise forceps on the left arm and monopolar cutting scissors on the right. Notable differences also occur at Step 11, when ligation of the renal artery and vein is performed by the bedside surgeon in RDN versus by the primary surgeon in LDN, and Step 12, when LDN involves kidney extraction via a hand-assist device, while RDN utilizes a specimen bag introduced through the assistant port with extraction through a Pfannenstiel incision. A preliminary comparison of 512 historical LDN cases versus 17 RDN cases reveals RDN has a lower intraoperative estimated blood loss, but similar operative time, warm ischemia time, length of stay, rates of transfusion, and conversion rate versus LDN. CONCLUSIONS We outline several differences in operative technique between RDN and LDN during ligation of the renal hilum and extraction of the kidney. Short-term outcomes appear similar between the two approaches, with the exception of significantly less estimated blood loss in RDN. © 2016FiguresReferencesRelatedDetails Volume 195Issue 4SApril 2016Page: e772 Advertisement Copyright & Permissions© 2016MetricsAuthor Information Michael Palese More articles by this author Jamie Pak More articles by this author Edward Chin More articles by this author Greg Gin More articles by this author Daniel Herron More articles by this author Susan Lerner More articles by this author Dianne LaPointe Rudow More articles by this author Antonios Arvelakis More articles by this author Scott Ames More articles by this author Alan Benvenisty More articles by this author Ron Shapiro More articles by this author Sander Florman More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

84 Robotic-assisted laparoscopic donor nephrectomy with transvaginal extraction of the kidney

84 Robotic-assisted laparoscopic donor nephrectomy with transvaginal extraction of the kidney

NEFRECTOMÍA ROBÓTICA DEL DONANTE VIVO PARA TRASPLANTE: PRIMER CASO EN LATINOAMÉRICA

Living robotic donor nephrectomy. The first case in Latin America Introduction: Living donor nephrectomy is the best alternative of treatment for patients with chronic renal disease. Even though open surgery remains the gold standard for donor nephrectomy, laparoscopic surgery has become a feasible alternative in referral centers. To minimize the long learning curve associated with this procedure, some centers have introduced robotic donor nephrectomy as a surgical option. Aim: To present the first robotic-assisted laparoscopic donor nephrectomy in Latin America. Clinical case: The donor is a 50 years old male, living-related to the recipient by affinity (husband/wife). The recipient is a 54 years old female with history of end-stage renal disease waiting to initiate dialysis program. A left transperitoneal robotic-assisted laparoscopic nephrectomy employing the da Vinci Si ® (Intuitive Surgical, Sunnyvale CA.) is performed. Mean operative time was 188 minutes with an estimated blood loss of 300 ml. Mean ischemia time was 6 minutes. The graft presented immediate function. Both patients were discharged at 72 h. Conclu- sion: Living donor robotic-assisted laparoscopic nephrectomy is a safe and viable procedure. Larger series are needed to establish its role.

Robotic-Assistance Does Not Enhance Standard Laparoscopic Technique for Right-Sided Donor Nephrectomy

To examine donor and recipient outcomes after right-sided robotic-assisted laparoscopic donor nephrectomy (RALDN) compared with standard laparoscopic donor nephrectomy (LDN) and to determine whether robotic-assistance enhances LDN. From December 2005 to January 2011, 25 patients underwent right-sided LDN or RALDN. An IRB-approved retrospective review was performed of both donor and recipient medical charts. Primary endpoints included both intraoperative and postoperative outcomes. Twenty right-sided LDNs and 5 RALDNs were performed during the study period. Neither estimated blood loss (76.4 mL vs. 30 mL, P = .07) nor operative time (231 min vs. 218 min, P = .61) were significantly different between either group (LDN vs. RALDN). Warm ischemia time for LDN was 2.6 min vs. 3.8 min for RALDN (P = .44). Donor postoperative serum estimated glomerular filtration rates (eGFR) were similar (53 vs. 59.6 mL/min/1.73 m2, LDN vs. RALDN, P = .26). For the recipient patients, posttransplant eGFR were similar at 6 months (53.4 vs. 59.8 mL/min/1.73 m2, LDN vs. RALDN, P = .53). In this study, robotic-assistance did not improve outcomes associated with LDN. Larger prospective studies are needed to confirm any perceived benefit of RALDN.

Robotic-assisted laparoscopic donor nephrectomies: early experience and review of the literature.

With over 80,000 patients in the United States awaiting kidney transplantation, renal transplant surgery continues to evolve with attractive surgical options for living donation, which include laparoscopic donor nephrectomy (LDN) and robotic-assisted laparoscopic donor nephrectomy (RALDN). LDN is currently accepted as the gold standard procedure for living donor nephrectomy; RALDN is an evolving technique and may emerge as a preferred procedure over time. We present our initial experience with RALDN from December 2007 to August 2008. Thirty-five patients who underwent RALND were retrospectively analyzed and compared with 35 age- and time (year)-matched patients who underwent LDN. The parameters analyzed were length of hospital stay (3.2±0.9days, P<0.59), estimated blood loss (146±363ml, P<0.36), operating time (149±44min, P<0.23), cold ischemic time (135±202min, P<0.19), preoperative creatinine (0.82±0.26mg/dl, P<0.46) and postoperative creatinine (1.44±1.03mg/dl, P<0.20). There was no statistical difference between RALDN patients with single renal artery (n=27) and those with more than one renal artery (n=8) kidneys. There was one serious complication requiring conversion to open laparotomy to control a bleeding renal artery stump following extraction of the kidney. One-year graft survival for the 35 recipients of RALDN was 97.1%. RALDN is feasible and compares favorably to the standard LDN procedure with good graft survival. Robotic-assisted transplant surgery is an emerging technique with potential benefits to both surgeon and patient.

Robotic-Assisted Laparoscopic Donor Nephrectomy with Transvaginal Extraction of the Kidney

Robotic-Assisted Laparoscopic Donor Nephrectomy with Transvaginal Extraction of the Kidney

Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies

The classic approach to donor nephrectomy consists of preferential procurement of the kidney without vascular anomalies. We studied the effect of routine procurement of the left kidney regardless the presence of multiple arteries on the outcomes of robotic-assisted laparoscopic living donor nephrectomy (LLDN) with particular reference to the incidence of urological complications. From August 2000 to July 2005, 209 left LLDNs were performed. We analyzed the outcomes of donors and recipients in relation to the presence of multiple vessels versus normal anatomy. We divided the patients into two groups: group A (n = 148) with normal vascular anatomy and group B (n = 61) with vascular anomalies. In the donors, no significant difference in conversion to open surgery rate, blood loss, length of stay, was noted between the two groups; operative time and warm ischemia time were slightly higher in group B. One-year patient survival was 98% in both groups while the 1-year graft survival was 96.6% in group A and 96% in group B. Only one urological complication was noted in the group with normal anatomy (0.7%) versus none in the group with multiple arteries. Left kidney procurement using robotic-assisted laparoscopic technique is safe and effective, even in the presence of vascular anomalies.

Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation.

Minimally invasive laparoscopic nephrectomy is a well-established alternative to open surgery in living donors for kidney transplantation. Donor mortality and morbidity rates as well as recipient outcome are comparable to the open approach. Furthermore, the procedure is associated with reduced donor discomfort, faster recovery, and improved cosmetic results. Recently, an advanced robotic system for laparoscopic surgery was approved for use in the United States. This system allows a greater freedom of movement and recreates the hand-eye coordination and three-dimensional vision that is lost in standard laparoscopic procedures. We report the first 12 successful cases of robotic-assisted laparoscopic living donor nephrectomy performed using the da Vinci Surgical System (Intuitive Surgical, Mountain View, CA). Our initial experience has shown that the system allows the performance of donor nephrectomy in a safe and accurate fashion. As technology continues to evolve, robotic-assisted surgery has the potential to become a widely used attractive alternative to standard laparoscopic donor nephrectomy.