Robotic-assisted kidney transplant: a single center experience with median follow-up of 2.8 years
- 25 Downloads
The main aim of the paper is to report a single-centre experience with RAKT, focusing on surgical, perioperative and functional outcomes at a median follow-up of 2.8 years.
Data of 26 RAKT patients was prospectively collected from December 2014 to February 2019 with follow-up of up to 55 months. All donors were done laparoscopically. We followed Vattikuti–Medanta technique with modification of using pfannenstiel incision instead of Gelpoint and patient positioned in steep Trendelenburg position (30°) with leg split position. Hypothermia was maintained using a “modified graft hypothermia jacket”. The engrafted kidney is oriented with the vessels being tagged with Prolene sutures.
The mean BMI was 26.1 ± 4.7. The mean warm, cold and total ischemia times were 4.8 ± 1.1, 113.8 ± 20.9 and 118.7 ± 21.2 min, respectively. Mean rewarming time was 62.5 ± 10 min. The mean post-operative day (POD) 1, 3, 7, 30, 6 months, 1 year and most recent creatinine was 3.4, 2.4, 1.8, 1.4,1.2, 1.2 and 1.69 mg/dl. There was no case of delayed graft dysfunction (DGF) with graft survival of 1.8-55 months. The mean GFR at POD 1, 1 month and 1 year was 24, 53.16 and 64.6. We had two intraoperative complications—one topsy turvy graft placement with anastomosis of donor ureter to native ureter and other had to be converted to open technique after anastomosis to control graft surface bleeding. Three postoperative complications—one patient has graft pyelonephritis which was managed conservatively with antibiotics. Two patients had lymphocele. One patient was managed with just aspiration while the other required laparoscopic de-roofing of the lymphocele. The mean hospital stay was 13.5 ± 3 days.
RAKT is feasible and safe only if performed by surgeons with appropriate background in robotic surgery and kidney transplantation after proper surgical training at experienced centres in the mid-term follow-up. Further studies need to confirm the long-term safety of RAKT.
KeywordsKidney transplantation Robot-assisted kidney transplantation RAKT Robotic surgery Vascular anastomosis
- 1.Collins AJ, Foley RN, Chavers B, Gilbertson D, Herzog C et al (2012) United States Renal Data System 2011 Annual Data Report: Atlas of chronic kidney disease and endstage renal disease in the United States. Am J Kidney Dis 59(Suppl 1:A7):e1–e420Google Scholar
- 2.Murray JE (2001) Surgery of the soul: reflections of a curious career. Science History Publications, CantonGoogle Scholar
- 20.Vignolini G, Campi R, Sessa F, Greco I, Larti A, Giancane S, Sebastianelli A, Gacci M, Peris A, Li Marzi V, Breda A, Siena G, Serni S (2019) Development of a robot-assisted kidney transplantation programme from deceased donors in a referral academic centre: technical nuances and preliminary results. BJU Int 123:474–484. https://doi.org/10.1111/bju.14588 CrossRefGoogle Scholar
- 21.Vignolini G, Sessa F, Greco I, Pili A, Giancane S, Sebastianelli A, Siena G, Gacci M, Li Marzi V, Campi R, Serni S (2018) Robotic kidney transplantation from a brain-dead deceased donor in a patient with autosomal dominant polycystic kidney disease: first case report. J Endourol Case Rep 4.1:124–128CrossRefGoogle Scholar
- 22.Siena G, Campi R, Decaestecker K, Tuğcu V, Sahin S, Alcaraz A, Musquera M, Territo A, Gausa L, Randon C, Stockle M, Janssen M, Fornara P, Mohammed N, Guirado L, Facundo C, Doumerc N, Vignolini G, Breda A, Serni S (2018) Robot-assisted kidney transplantation with regional hypothermia using grafts with multiple vessels after extracorporeal vascular reconstruction: results from the European Association of Urology Robotic Urology Section Working Group. Eur Urol Focus 4(2):175–184CrossRefGoogle Scholar
- 23.Territo A, Gausa L, Alcaraz A, Musquera M, Doumerc N, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Sahin S, Tuǧcu V, Basile G, Breda A (2018) European experience of robot-assisted kidney transplantation: minimum of 1-year follow-up. BJU Int 122:255–262. https://doi.org/10.1111/bju.14247 CrossRefGoogle Scholar
- 24.Vignolini G, Sessa F, Greco I, Cito G, Vanacore D, Cocci A et al (2019) Intraoperative assessment of ureteral and graft reperfusion during robotic kidney transplantation with indocyanine green fluorescence videography. Minerva Urol Nefrol 71:79–84. https://doi.org/10.23736/S0393-2249.18.03278-2 CrossRefGoogle Scholar
- 29.Sood A, Ghani KR, Ahlawat R et al (2014) Application of the statistical process control method for prospective patient safety monitoring during the learning phase: robotic kidney transplantation with regional hypothermia (IDEAL phase 2a-b). Eur Urol 66(2):371–378. https://doi.org/10.1016/j.eururo.2014.02.055 CrossRefGoogle Scholar