Robotic Kidney Transplantation Research Articles

Letter to the editor: a commentary on 'successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience'.

Letter to the editor: a commentary on 'successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience'.

Robotic kidney transplantation.

Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patientswith obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach.

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.

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

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

Robotic Kidney Transplant Beyond the Learning Curve: 8-Year Single-center Experience and Matched Comparison With Open Kidney Transplant

ObjectivesTo investigate the medium to long-term outcomes of RAKT and propensity matched comparison with Open kidney transplant (OKT). Material and methodsWe retrospectively reviewed 342 patients from database, who underwent RAKT and OKT from January 2015 to May 2022, at our centre. Various demographic, intraoperative and postoperative parameters were evaluated. Statistical analysis including propensity matching using nearest neighbour algorithm was performed to ensure comparability between the RAKT and OKT groups.The statistical analyses were performed using SPSS v.22.0 (IBM Corp., Armonk, NY, USA) and STATA 13 (Stata Corp., College Station, TX, USA). All statistical tests were two-sided, and a significance level of p < 0.05 was considered statistically significant. ResultsAfter applying exclusion criteria,196 RAKT patients and 102 OKT patients were included in the analysis. Propensity score matching resulted in the inclusion of 173 patients in the RAKT group. In the propensity-matched comparison of intra/perioperative parameters, RAKT showed significant reductions in total surgical time (p <0.001), wound length (p < 0.001), blood loss (p <0.001), blood transfusion rate (p <0.001), pain score (p < 0.001), and analgesia requirement (p< 0.001). Graft survival and patient survival rates were comparable in RAKT and OKT groups at the end of 60 months. ConclusionRAKT offers several advantages over OKT in terms of reduced operative time, blood loss, pain, and analgesia requirements. RAKT shows comparable graft and patient survival rates to OKT in the medium to long term.

PD17-03 REDOX IMBALANCE AND MAPK ACTIVATION MEDIATES PNEUMOPERITONEUM-INDUCED KIDNEY INJURY DURING MINIMALLY INVASIVE SURGERY

You have accessJournal of UrologyCME1 Apr 2023PD17-03 REDOX IMBALANCE AND MAPK ACTIVATION MEDIATES PNEUMOPERITONEUM-INDUCED KIDNEY INJURY DURING MINIMALLY INVASIVE SURGERY Charbel Chalouhy, Nassim Fares, Youakim Saliba, Pedro Maria, Ahmed Aboumoouhamed, Marwan Kassis, Alexander Small, and Justin Loloi Charbel ChalouhyCharbel Chalouhy More articles by this author , Nassim FaresNassim Fares More articles by this author , Youakim SalibaYouakim Saliba More articles by this author , Pedro MariaPedro Maria More articles by this author , Ahmed AboumoouhamedAhmed Aboumoouhamed More articles by this author , Marwan KassisMarwan Kassis More articles by this author , Alexander SmallAlexander Small More articles by this author , and Justin LoloiJustin Loloi More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003272.03AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Given the widespread use of laparoscopic and robotic surgeries, the effects of pneumoperitoneum (PNP) during minimally invasive surgery on kidney function become of great interest. PNP during laparoscopy causes transient renal functional impairment via various detrimental factors, such as oxidative stress. We, therefore, investigated the oxidative signaling pathways inherent to PNP-induced kidney injury. METHODS: PNP was established at an intraperitoneal CO 2 pressure of 12 mmHg in Wistar rats randomly allocated into three groups: Sham, PNP1, and PNP24. PNP1 and PNP24 animals were sacrificed at one and 24 hours following PNP deflation, respectively. Renal histology, function, redox status, and signaling pathways were assessed. RESULTS: PNP induced kidney injury and dysfunction with altered KIM-1 profile. Both expression and activity of antioxidant (CAT, SOD1/2) and oxidant (NOS3) enzymes, lipid peroxidation, and renal RNA/DNA damage biomarkers revealed redox imbalance after PNP, with an excess H2O2 production. Moreover, the antioxidant gene regulators FoxO3a and Nrf2 were activated. Nevertheless, PNP had no effect on the cellular apoptotic pathways Bcl2, Bid, Caspase 3 and 8. Finally, PNP stimulated the p38 and JNK mitogen-activated protein kinase (MAPK) pathways in the kidney. CONCLUSIONS: Our results demonstrate for the first time that PNP induces acute kidney injury due to renal redox imbalance linked to MAPK activation. These insights may open the way for further investigation into the renal therapeutic impact of managing PNP-associated oxidative stress during robotic surgery and explore procedure-specific kidney function recovery patterns i.e. after robotic partial nephrectomy or robotic kidney transplant. Source of Funding: none © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e495 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charbel Chalouhy More articles by this author Nassim Fares More articles by this author Youakim Saliba More articles by this author Pedro Maria More articles by this author Ahmed Aboumoouhamed More articles by this author Marwan Kassis More articles by this author Alexander Small More articles by this author Justin Loloi More articles by this author Expand All Advertisement PDF downloadLoading ...

V03-01 SINGLE-PORT KIDNEY AUTO-TRANSPLANTATION (SP-KAT) WITH BOARI FLAP URETERAL REIMPLANT: DESCRIPTION OF OUR NOVEL APPROACH

You have accessJournal of UrologyCME1 Apr 2023V03-01 SINGLE-PORT KIDNEY AUTO-TRANSPLANTATION (SP-KAT) WITH BOARI FLAP URETERAL REIMPLANT: DESCRIPTION OF OUR NOVEL APPROACH Jaya Sai Chavali, Jihad Kaouk, Ethan Ferguson, Roxana Ramos, Albert Geskin, Alvin Wee, and Mohamed Eltemamy Jaya Sai ChavaliJaya Sai Chavali More articles by this author , Jihad KaoukJihad Kaouk More articles by this author , Ethan FergusonEthan Ferguson More articles by this author , Roxana RamosRoxana Ramos More articles by this author , Albert GeskinAlbert Geskin More articles by this author , Alvin WeeAlvin Wee More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003241.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: We aim to demonstrate the feasibility and safety of the novel minimally invasive technique for efficient, multiquadrant robotic kidney transplantation using da Vinci single-port robot platform (SP-KAT). The study patient had a good split renal function and complete ureter avulsion. METHODS: Eight consecutive patients underwent SP KAT using the DaVinci SP platform. Overall patient clinicopathologic variables were recorded in Table 1. We demonstrate our technique in 58 year old male that presented after complete avulsion of the ureter during ureteroscopy. He had good split renal function on imaging. Technical steps of the surgery included (1). Robotic nephrectomy; (2) Kidney benching; (3) Dissection of Iliac vessels and Kidney placement; (4) Vascular anastomosis; (5) Ureteral reimplant. Extra corporeal kidney benching performed at the same time while the iliac vessels are being exposed robotically for subsequent transplant. This patient in addition required Boari flap ureteroneocystostomy due to insufficient length of ureter. RESULTS: All SP KAT cases were successfully performed without repositioning or conversion to open. Total operative time was 701 minutes. Estimated blood loss was 500cc. The Foley and stent removed at 2 and 6 weeks postoperatively. Patient had complete preservation of renal function. No documented postoperative complications up to latest follow up at 1 year. CONCLUSIONS: We demonstrate our single-port efficient, multiquadrant robotic kidney transplantation technique performed though a single incision further reducing surgical morbidity. All the cases were completed successfully without conversion or loss of graft function. Source of Funding: None © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e246 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jaya Sai Chavali More articles by this author Jihad Kaouk More articles by this author Ethan Ferguson More articles by this author Roxana Ramos More articles by this author Albert Geskin More articles by this author Alvin Wee More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement PDF downloadLoading ...

Robotic kidney transplantation from deceased donors: A single-center experience

Robotic-assisted kidney transplant (RAKT) has proven to be a successful approach for patients with elevated body mass index (BMI). To date, a paucity of studies comprehensively analyzing the clinical outcomes of RAKT by using the grafts from deceased donors exists. This was a single-center retrospective analysis of RAKT from deceased donor kidneys (n = 93) from 2009 to 2021. The cohort was divided into 3 groups on the basis of recipient BMI (BMI ≤ 41.2 vs BMI 41.2-44.5 vs BMI ≥ 44.5 kg/m2, n = 31). Delayed graft function was significantly higher in the group with the highest BMI (BMI ≤ 41.2 vs BMI 41.2-44.5 vs BMI ≥ 44.5 kg/m2, 12.5% vs 10% vs 45.16%, P = .001). Graft survival after 12 months of follow-up was significantly lower in the group with BMI of ≥44.5 kg/m2 (BMI ≤ 41.2 vs BMI 41.2-44.5 vs BMI ≥ 44.5 kg/m2, 93.7% vs 100% vs 83.9%. P = .05). For BMI, the relative risk of patient survival was 1.10 for each increase in a BMI in the range of 5 (CI 95%, 0.98-1.21). Death-censored graft survival after 5 years was significantly better than the UNOS-matched cohort (dRAKT vs match, 86.2% vs 68.9%, P = .03). This single-center analysis shows that RAKT can be performed safely; however, caution should be used when matching marginal kidneys with patients with high BMI.

Comparison of outcomes after open versus robotic kidney transplantation: A systematic review and meta-analysis.

This meta-analysis compares the clinical outcomes of robot-assisted kidney transplant (RAKT) to open kidney transplant (OKT). A systematic search of Scopus and MEDLINE databases was carried out using a combination of keywords to identify studies comparing RAKT to OKT. Baseline characteristics and preoperative and postoperative data were collected along with data on the short- and long-term outcomes. The study was registered in PROSPERO and Assessing the Methodological Quality of Systematic Reviews and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. A total of 16 studies were included with a total of 2555 patients, of which 677 underwent RAKT and 1878 underwent OKT. This meta-analysis shows a significant benefit of RAKT over OKT in terms of less intra-operative blood loss, smaller incision length, less postoperative pain scores at 24 and 48 hours, and a lower incidence of surgical site infections (SSIs), especially in obese patients. In addition, the incidence of postoperative lymphoceles was lower in the RAKT group compared to the OKT group, although not statistically significant. There was no difference between the two groups in terms of short-term graft functional outcomes and overall survival. The number of deceased donor recipients undergoing RAKT was very small. At the time of reporting this meta-analysis, no randomized controlled trials (RCTs) had been published. This meta-analysis showed that RAKT is a safe and feasible alternative to OKT, especially in obese individuals. Further trials are needed to confirm the safety, efficacy, and cost-effectiveness of RAKT.

Robotic kidney transplantation: a single institutional experience

Robotic kidney transplantation: a single institutional experience

Robotic Kidney Transplantation Under Regional Hypothermia.

The technique of robotic kidney transplantation (RKT) under regional hypothermia is being described. It may be performed in all patients requiring kidney transplantation with some relative contraindications. Unlike open transplantation, RKT is a transperitoneal procedure. Patient lies supine with low lithotomy and 15° to 20° reverse Trendelenburg position. Port placement is like standard radical prostatectomy with a multiport device placed at the umbilicus. The graft after harvest needs special care on the bench to ligate all vascular communications and placed in a gauze jacket for easy handling. After transplant bed preparation, the graft is introduced in peritoneal cavity through the umbilical opening and placed over the bladder flap bed with ice slush for hypothermia. End-to-side vascular anastomoses of renal vein and artery are done with the graft lying in pelvic hollow and renal vessels facing laterally to external iliac vessels. After vascular anastomoses, the graft is rotated laterally to iliac fossa to be fixed with preformed peritoneal flap. A stented ureterovesicostomy to the recipient is done using extravesical technique. The external opening for introducing the graft and the robotic port openings is closed after leaving a drain. Postoperative (PO) care and PO immunosuppression are like the open counterpart, except the treatment of drain, which is removed on second PO day. Obese recipients and multiple graft vessels may be handled comfortably during RKT with described techniques. It is important to follow certain checkpoints to avoid bleeding. With graft and patient survival of 95.2% and 94.5%, respectively, RKT outcomes are noninferior to open technique in the published data. The RKT has less incidence of PO pain, wound infection, and symptomatic lymphoceles.

236.3: Non Hand Assisted Robotic Kidney Transplantation: The Future.

236.3: Non Hand Assisted Robotic Kidney Transplantation: The Future.

Simultaneous Robotic-Assisted Bilateral Native Nephrectomy and Kidney Transplantation for Autosomal Dominant Polycystic Kidney Disease in Recipients With High Body Mass Index: Report of 2 Cases

Robotic kidney transplantation is a safe, reproducible, and less morbid technique in high body mass index and end-stage renal disease. Polycystic kidney disease is a relative contraindication to robotic-assisted kidney transplantation because of the mass effect of the native kidneys on the patient's pelvis that prevents ideal exposure. We report the first 2 cases of robotic-assisted simultaneous bilateral nephrectomy and kidney transplantation for patients with obesity and adult polycystic kidney disease. The recipients were 2 males, 50 and 53 years old, with a body mass index of 35.1 41.6 kg/m2 and 41.6 kg/m2, respectively. Both recipients had suitable living donors. The average operating time was 395 minutes and the estimated blood loss was on average 250 mL. The postoperative course was uneventful and the patients were discharged home on days 4 and 5. Performing robotic nephrectomies simultaneously with kidney transplantation can be done safely, allowing patients with obesity and polycystic kidney disease needing bilateral nephrectomy, to take full advantage of minimally invasive kidney transplantation.

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 ...

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

SC144 - Is robotic kidney transplantation non-inferior to open kidney transplantation in the setting of deceased donors? A single-centre preliminary experience

SC144 - Is robotic kidney transplantation non-inferior to open kidney transplantation in the setting of deceased donors? A single-centre preliminary experience

MP37-01 SINGLE-PORT ROBOTIC KIDNEY TRANSPLANTATION: TRANSITIONING TO THE EXTRAPERITONEAL APPROACH

You have accessJournal of UrologyRenal Transplantation & Vascular Surgery I (MP37)1 Sep 2021MP37-01 SINGLE-PORT ROBOTIC KIDNEY TRANSPLANTATION: TRANSITIONING TO THE EXTRAPERITONEAL APPROACH Jihad Kaouk, Mahmoud Abou Zeinab, Alp T. Beksac, Yi-Chia Lin, Alireza Aminsharifi, Zeyad Schwen, Alvin Wee, and Mohamed Eltemamy Jihad KaoukJihad Kaouk More articles by this author , Mahmoud Abou ZeinabMahmoud Abou Zeinab More articles by this author , Alp T. BeksacAlp T. Beksac More articles by this author , Yi-Chia LinYi-Chia Lin More articles by this author , Alireza AminsharifiAlireza Aminsharifi More articles by this author , Zeyad SchwenZeyad Schwen More articles by this author , Alvin WeeAlvin Wee More articles by this author , and Mohamed EltemamyMohamed Eltemamy More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000002046.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Robotic kidney transplantation (RKT) is a new minimally invasive alternative to the standard open approach. The single port robotic approach has the potential to decrease surgical morbidity and allows for an extraperitoneal approach compared to the current robotic practice that is limited to the transperitoneal space. We present the perioperative and postoperative outcomes of our initial 7 patients who underwent SP RKT. METHODS: Seven patients with end stage renal disease (ESRD) due to different causes underwent SP RKT. Both transperitoneal (cases 1-3) and extraperitoneal (cases 4-7) approaches were used. All robotic transplant cases were completed successfully through a single periumbilical incision without the need of any additional ports. Intracorporeal ice was implemented in the last 3 cases. We prospectively collected the perioperative data and postoperative kidney function by frequent serum creatinine measurement, and protocol biopsies at 3-6 months and 1 year after transplantation. RESULTS: The mean age at transplantation was 55 years, mean BMI was 30 kg/m2 and four patients were males. Three patients had preemptive RKT, three were previously on intermittent hemodialysis and one patient was on peritoneal dialysis. Median (IQR) total operative and vascular anastomosis times were 372 (365,444) and 53 minutes (46, 56) respectively. All patients had good urine output during the first 24 hours and progressive improvement of graft function. None of them had delayed graft function requiring dialysis. Median (IQR) hospital stay was 2 days (2, 3) and median pain score at discharge was 2. Median creatinine level at 2 weeks, 1 month and 1 year were 1.5, 1.3, and 1.1 mg/dL respectively. All patients up to 1 year follow up had no acute rejection on protocol biopsies. CONCLUSIONS: RKT using the new single-port platform is feasible and can be safely performed through the extraperitoneal approach. This approach provides patients with less surgical morbidity and successful graft functional outcomes. Source of Funding: None © 2021 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 206Issue Supplement 3September 2021Page: e645-e645 Advertisement Copyright & Permissions© 2021 by American Urological Association Education and Research, Inc.MetricsAuthor Information Jihad Kaouk More articles by this author Mahmoud Abou Zeinab More articles by this author Alp T. Beksac More articles by this author Yi-Chia Lin More articles by this author Alireza Aminsharifi More articles by this author Zeyad Schwen More articles by this author Alvin Wee More articles by this author Mohamed Eltemamy More articles by this author Expand All Advertisement Loading ...

Robotic Kidney Transplant: The Modern Era Technical Revolution.

Since the mid 20th century, transplantation has been a fast-developing field of contemporary medicine. The technical aspects of transplant operations were developed in the 1950s, with little significant change for >50 y. Those techniques allowed completion of various organ transplants and successful patient outcomes, but they also carried the inherent disadvantages of open surgery, such as postoperative pain, wound complications and infections, and prolonged length of hospital stay. The introduction and adoption of minimally invasive surgical techniques in the early 1990s to various surgical specialties including general, gynecologic, and urologic surgery led to significant improvements in postoperative patient care and outcomes. Organ transplantation, with its precision demanding vascular anastomoses, initially had been considered infeasible to accomplish with conventional laparoscopic devices. The institution of robotic surgical technology in the late 1990s and its subsequent wide utilization in fields of surgery changed its accessibility and acceptance. With the steady camera, 3D views, and multidirectional wrist motions, surgical robotics opened new horizons for technically demanding surgeries such as transplantation to be completed in a minimally invasive fashion. Furthermore, the hope was this technique could find a niche to treat patients who otherwise are not deemed surgical candidates in many fields including transplantation. Here in, robotics in kidney transplantation and its ability to help provide equity through access to transplantation will be discussed.

P0346 - Four-year experience with robotic kidney transplantation from deceased donors: Overcoming logistical and technical challenges to broaden the indications of robotic kidney transplantation

P0346 - Four-year experience with robotic kidney transplantation from deceased donors: Overcoming logistical and technical challenges to broaden the indications of robotic kidney transplantation