Robotic Donor Nephrectomy Research Articles

Revolutionizing Organ Transplantation With Robotic Surgery.

The aim of this study was to evaluate the impact of robotic techniques on organ transplantation outcomes. The evolution of organ transplantation is becoming influenced by the adoption of minimally invasive techniques, transitioning from laparoscopic to robotic methods. Robotic surgery has emerged as a significant advancement, providing superior precision and outcomes compared with traditional approaches. This perspective includes a systematic review of the literature, original data from a high-volume center, as well as an international survey focusing on perceptions related to robotic versus laparoscopic and open approaches. The systematic review and meta-analysis revealed lower morbidity with robotic donor nephrectomy, recipient kidney transplant and donor hepatectomy. Our center's experience, with over 3000 minimally invasive transplant procedures (kidney, liver, donor, and recipient), supports the superiority of robotic transplant surgery (RTS). The global survey confirms this shift, revealing a preference for robotic approaches due to their reduced morbidity, despite challenges such as access to the robotic system and cost. This comprehensive overview including a systematic review, original data, and perceptions derived from the international survey demonstrate the superiority of robotic transplant surgery (RTS) across a range of organ transplantations, for both donors and recipients. The future of RTS depends on the efforts of the surgical community in addressing challenges such as economic implications, the need for specialized surgical training for numerous surgeons, as well as wide access to robotic systems worldwide.

Robotic living donor nephrectomy is associated with reduced post-operative opioid use compared to hand-assisted laparoscopic approach.

Robotic donor nephrectomy (RDN) has emerged as a safe alternative to laparoscopic donor nephrectomy (LDN). Having previously demonstrated comparable efficacy, this study aims to examine postoperative analgesia use (opioid and non-opioid) in the two groups. We conducted a retrospective review of 300 living donor nephrectomies performed at our center, comparing 150 RDN's with a contemporary cohort of 150 hand-assisted LDN's. In addition to clinical and demographic information, data on postoperative inpatient opioid and non-opioid analgesia (from patient's arrival to the surgical floor after surgery till the time of discharge) was collected. Opioid dosages were standardized by conversion to morphine milligram equivalents (MME). All patients were managed post-operatively under a standardized ERAS pathway for living donor nephrectomy patients. There were no significant differences in donor age, gender, and BMI between RDN and LDN groups. Total post-operative opioid use (MME's) was significantly lower in RDN patients (RDN 27.1 vs. LDN 46.3; P < 0.0001). Breakdown of opioid use with post-operative (POD) day demonstrated significantly lower use in RDN group on POD1 (RDN 8.6 vs. LDN 17.0; P < 0.05), and POD2 (RDN 3.9 vs LDN 10; P < 0.05). RDN patients had a shorter post-operative length of stay (LOS) (RDN 1.69days vs. LDN 1.98; P = 0.0003). There were no differences between groups in non-opioid medication use, complications, and readmission rates. RDN has comparable safety to hand-assist LDN and offers additional benefits of lower postoperative opioid requirement and a shorter hospital LOS.

Comparison of Single-Port Robotic Donor Nephrectomy and Laparoscopic Donor Nephrectomy.

Purpose: To compare the intra- and postoperative outcomes of single-port robotic donor nephrectomies (SP RDNs) and laparoscopic donor nephrectomies (LDNs). Materials and Methods: We retrospectively reviewed our institutional database for patients who received LDN or SP RDN between September 2020 and December 2022. Donor baseline characteristics, intraoperative outcomes, postoperative outcomes, and recipient renal function were extracted and compared between LDN and SP RDN. SP RDN learning curve analysis based on operative time and graft extraction time was performed using cumulative sum analysis. Results: One hundred forty-four patients underwent LDN and 32 patients underwent SP RDN. LDN and SP RDN had similar operative times (LDN: 190.3 ± 28.0 minutes, SP RDN: 194.5 ± 35.1 minutes, p = 0.3253). SP RDN patients had significantly greater extraction times (LDN: 83.2 ± 40.3 seconds, SP RDN: 204.1 ± 52.2 seconds, p < 0.0001) and warm ischemia times (LDN: 145.1 ± 61.7 seconds, SP RDN: 275.4 ± 65.6 seconds, p < 0.0001). There were no differences in patient subjective pain scores, inpatient opioid usage, or Clavien-Dindo II+ complications. Short- and medium-term postoperative donor and recipient renal function were also similar between the groups. SP RDN graft extraction time and total operative time learning curves were achieved at case 27 and 13, respectively. Conclusion: SP RDN is a safe and feasible alternative to LDN that minimizes postoperative abdominal incisional scars and has a short learning curve. Future randomized prospective clinical trials are needed to confirm the findings of this study and to identify other potential benefits and drawbacks of SP RDNs.

Robotic Versus Laparoscopic Donor Nephrectomy: A Retrospective Bicentric Comparison of Learning Curves and Surgical Outcomes From 2 High-volume European Centers.

Although laparoscopic donor nephrectomy (LDN) represents the gold-standard technique for kidney living donation, robotic donor nephrectomy (RDN) settled as another appealing minimally invasive technique over the past decades. A comparison between LDN and RDN outcomes was performed. RDN and LDN outcomes were compared, focusing on operative time and perioperative risk factors affecting surgery duration. Learning curves for both techniques were compared through spline regression and cumulative sum models. The study analyzed 512 procedures (154 RDN and 358 LDN procedures) performed between 2010 and 2021 in 2 different high-volume transplant centers. The RDN group presented a higher prevalence of arterial variations (36.2 versus 22.4%; P = 0.001) compared with the LDN cohort. No open conversions occurred; operative time (210 versus 195 min; P = 0.011) and warm ischemia time (WIT; 230 versus 180 s; P < 0.001) were longer in RDN. Postoperative complication rate was similar (8.4% versus 11.5%; P = 0.49); the RDN group showed shorter hospital stay (4 versus 5 d; P < 0.001). Spline regression models depicted a faster learning curve in the RDN group ( P = 0.0002). Accordingly, cumulative sum analysis highlighted a turning point after about 50 procedures among the RDN cohort and after about 100 procedures among the LDN group.Higher body mass index resulted as an independent risk factor for longer operative time for both techniques; multiple arteries significantly prolonged operative time in LDN, whereas RDN was longer in right kidney procurements; both procedures were equally shortened by growing surgical experience. RDN grants a faster learning curve and improves multiple vessel handling. Incidence of postoperative complications was low for both techniques.

Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy.

Robotic donor nephrectomy (RDN) has emerged as a safe alternate to laparoscopic donor nephrectomy (LDN), offering improved visualization, instrument dexterity and ergonomics. There is still concern about how to safely transition from LDN to RDN. We performed a retrospective review of 150 consecutive living donor operations (75 LDN and 75 RDN) at our center, comparing the first 75 RDN's with the last 75 LDN's performed prior to the initiation of the robotic transplant program. Operative times and complications were used as surrogates of efficiency and safety, respectively, to estimate the learning curve with RDN. RDN was associated with a longer total operative time (RDN 182 vs LDN 144min; P < 0.0001) but a significantly shorter post-operative length of stay (RDN 1.8 vs LDN 2.1days; P = 0.0213). Donor complications and recipient outcomes were the same between both groups. Learning curve of RDN was estimated to be about 30 cases. RDN is a safe alternate to LDN with acceptable donor morbidity and no negative impact on recipient outcomes even during the early part of the RDN learning curve. Surgeon preferences for the robotic approach compared to traditional laparoscopy will require further scrutiny to improve ergonomics and operative efficiency.

Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies.

Introduction and Objective: Despite the adoption of robotic donor nephrectomy, the steep learning curve of robotic recipient transplantation has hindered the implementation of a complete robot-assisted kidney transplantation (RAKT). We sought to develop a high-fidelity perfused full immersion nonbiohazardous platform for RAKT simulation training. Methods: A three-dimensional (3D) computer-aided design (CAD) model consisting of a kidney, pelvicaliceal system, renal artery, and vein was created from a CT scan of a donor patient. 3D printed casts designed from the CAD model were injected with various polyvinyl alcohol hydrogel formulations to fabricate an anatomical kidney phantom and surrounding abdominal cavity. The process was repeated using a recipient's CT scan to create the recipient pelvic model containing a bony pelvis, pelvic musculature, iliac arteries and veins, and bladder. Donor and recipient models each contained structures to simulate the perfused vascular and ureterovesical anastomosis. A board-certified transplant surgeon completed a robotic training curriculum, including four RAKT simulation procedures, from procurement of the donor kidney to final retroperitonealization. Metrics from the simulations (e.g., arterial, venous, ureterovesical, and total anastomosis times) were recorded and compared with surgical times from published data. Results: The average time for the nephrectomies was 67.33 (±31.58) minutes. The average total anastomosis time was 60.85 (±9.73) minutes with 20.37 (±3.87), 20.17 (±4) and 15.1 (±2.35) minutes for arterial, venous, and ureterovesical anastomosis, respectively. The recorded arterial and venous anastomosis times were within published times for competency (Δ = 2.47 and Δ = 2.87, respectively), whereas the uterovesical time was within the mastery range (Δ = 0.45). Conclusions: Using a combination of 3D printing and hydrogel casting technologies, a high fidelity perfused full-immersion nonbiohazardous simulation platform for RAKT was developed. The utilization of this platform has the potential to replace the early cases in a learning curve while decreasing the barriers to utilization for transitioning transplant surgeons.

118.1: Single center outcomes after fully robotic live donor nephrectomy: right versus left.

118.1: Single center outcomes after fully robotic live donor nephrectomy: right versus left.

Robotic Donor Nephrectomy: The Right Way Forward

Donor nephrectomy is an extremely challenging procedure. The stakes are high, as two lives-the donor and the recipient-depend on it. Robotic donor nephrectomy has an edge over a laparoscopic approach.

Totally Robotic Donor Nephrectomy for Living Related Kidney Transplantation: Initial Experience.

Totally Robotic Donor Nephrectomy for Living Related Kidney Transplantation: Initial Experience.

Completely Intracorporeal Robotic Renal Autotransplantation

We describe a technique of complete intracorporeal renal autotransplantation with donor nephrectomy and transplantation performed in a minimally invasive fashion without extracting the kidney. We developed this technique of a completely intracorporeal robotic renal autotransplantation and determined the feasibility of this novel procedure. This includes a method of intracorporeal transarterial hypothermic renal perfusion using a perfusion catheter through a laparoscopic port. The procedure was successfully applied in a 56-year-old man with extensive left ureteral loss after failed ureteroscopy for ureterolithiasis. Robotic donor nephrectomy was performed with a warm ischemia timeof 2.3 minutes. Subsequently cold ischemia was achieved by intracorporeal hypothermic renal perfusion for 95.5 minutes. Vascular anastomoses and ureteroureterostomy in the ipsilateral pelvis were completed afterdonor nephrectomy with a total overall surgeon console time of 334 minutes. Venous and arterial anastomosis times were 17.3 and 21.3 minutes, respectively. Estimated blood loss was less than 50 ml. There were no complications and the patient wasdischarged home on postoperative day 1 after normal Doppler transplant renal ultrasound. Postoperative renal scan at 6weeks, intravenous urogram at8weeks and computerized tomography urography at5 months revealed normal function and successful ureteral reconstruction. We report the feasibility of a technique of a completely intracorporeal robotic renal autotransplantation. This operation may be considered inselect patients in the hands of experienced robotic surgeons. However, furtherrefinement is required as this novel procedure is cautiously reproduced and adopted by others.

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.

V7-04 COMPLETELY INTRACORPOREAL ROBOTIC RENAL AUTOTRANSPLANTATION

You have accessJournal of UrologyTrauma/Robotics1 Apr 2014V7-04 COMPLETELY INTRACORPOREAL ROBOTIC RENAL AUTOTRANSPLANTATION Dan Gilbert Dan GilbertDan Gilbert More articles by this author View All Author Informationhttps://doi.org/10.1016/j.juro.2014.02.2034AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookTwitterLinked InEmail INTRODUCTION AND OBJECTIVES Totally intracorporeal robotic donor nephrectomy with autotransplantation has not been previously described. We present a video demonstration of this novel procedure. METHODS A 56 year old man who suffered extensive ureteral loss after infectious complications of a perforated ureter presented for surgical management and was offered nephrectomy, ileal interposition, or renal autotransplantation with ureteroureterostomy. As a stone former, he chose the latter. This was performed with a total of 5 ports, including three 8mm robotic ports for robotic instruments. The donor nephrectomy was performed first robotically with cold perfusion of the renal artery intracorporeally with a catheter through the assistant port while the kidney was moved to the pelvis for vascular anastomosis to the external iliac vessels. A ureteroureterostomy was then performed over a stent. RESULTS Console time was 5 hours and 43 minutes, and the entire procedure was performed intracorporeally with only 5 port incisions. Venous anastomosis time was 17 minutes during which the kidney was cold perfused, and arterial anastomosis time was 21 minutes. Blood loss was 25cc, and the patient was discharged on the first postoperative day with no complications. Doppler ultrasound showed excellent flow prior to discharge, and renal scan at 6 weeks confirmed excellent graft function. Ureteral patency was confirmed at 3 months by IVP. CONCLUSIONS We present the first report of a completely intracorporeal robotic donor nephrectomy and renal autotransplantation. This complex procedure should be offered selectively but with caution by highly experienced robotic renal surgeons. © 2014FiguresReferencesRelatedDetails Volume 191Issue 4SApril 2014Page: e736 Advertisement Copyright & Permissions© 2014MetricsAuthor Information Dan Gilbert More articles by this author Expand All Advertisement Advertisement PDF downloadLoading ...

Completely Intracorporeal Robotic Renal Autotransplantation

Abstract Introduction and Objectives: Totally intracorporeal robotic donor nephrectomy with autotransplantation has not been previously described. We present a video demonstration of this novel pro...

V3 First clinical application: Transvaginal hybrid NOTES robotic donor nephrectomy

V3 First clinical application: Transvaginal hybrid NOTES robotic donor nephrectomy

Transvaginal Hybrid Natural Orifice Transluminal Surgery Robotic Donor Nephrectomy: First Clinical Application

To report a novel surgical approach of transvaginal hybrid natural orifice transluminal surgery (NOTES) living donor nephrectomy. We conceptualized this approach by incorporating 2 existing concepts: laparoendoscopic single-site surgery and NOTES. After thorough consent and under institutional review board approval, a 61-year-old woman volunteered to donate her kidney through hybrid transvaginal NOTES. Under general anesthesia, she was placed in a modified right lateral decubitus position. A SILS port and an 8-mm trocar were placed through the same umbilical incision. The GelPoint port was placed transvaginally via the posterior fornix, and the robot was docked. After dissection of the left kidney in preparation for extraction, the robot was undocked, and the retrieval bag was inserted through the GelPoint port. The graft was bagged before vessel stapling and extracted without breaching the bag. The kidney was delivered to the perfusion table with a clean pair of gloves without contamination with the bag exterior. Donor nephrectomy was successfully completed without conversion or perioperative complications. The total operative time was 240 minutes, the warm ischemic time was 5.8 minutes, and the estimated blood loss was 75 mL. No complications occurred and extra ports were not needed. The patient was discharged after an uneventful 48-hour stay. Her creatinine was 1.0 mg/dL at 4 weeks of follow-up. The recipient was given pulse steroids for biopsy-proven acute rejection, and her serum creatinine was 1.16 mg/dL at 4 weeks postoperatively. Transvaginal hybrid NOTES robotic donor nephrectomy is feasible. Additional advances in robotic technology are awaited for development of this approach and to foster its clinical application.

Renal Artery Aneurysm in Robotic Donor Nephrectomy: A Case Report

With the current disparity between donor organ availability and recipient need, creative techniques help optimize the use of available organs. We present a case of a woman, who was worked-up as a kidney donor, who was incidentally found to have a saccular aneurysm on her renal artery. The patient was asymptomatic, normotensive, and had normal renal function. We performed a laparoscopic robotic donor nephrectomy, repaired the aneurysm on the back table, and transplanted the organ into the recipient. The donor underwent a successful robotic nephrectomy, successfully eradicating any risk of aneurysmal complications; the recipient received an anatomically normal organ with excellent function. An altruistic act by the donor identified a potentially fatal lesion, which was not only remedied, but the intended donation proceeded when a creative approach was used.

Robotically assisted donor nephrectomy for kidney transplantation

The application of minimally invasive techniques in the field of transplant surgery is expanding the number of living-related donor nephrectomies. In 2003, the number of living kidney donors exceeded the number of cadaveric donors. The laparoscopic techniques already have been described extensively. Our experience with robotic donor nephrectomy began in October 2000. In this article, we describe the surgical technique for living-related donor nephrectomies using robotic technology (computer-enhanced surgery), as well as the most important considerations regarding the pre- and postoperative management of this group of patients.