V06-05 Orthotopic Robot-Assisted Kidney Transplantation: Surgical Technique and Preliminary Results

You have accessJournal of UrologyMisc. Benign/ Transplant/ Renovascular (V06)1 May 2024V06-05 ORTHOTOPIC ROBOT-ASSISTED KIDNEY TRANSPLANTATION: SURGICAL TECHNIQUE AND PRELIMINARY RESULTS Alessio Pecoraro, Begoña Etcheverry, Josep Maria Gaya, Angelo Territo, Andrea Gallioli, Camille Berquin, Giuseppe Basile, Pietro Diana, Thomas Prudhomme, Nicolas Doumerc, Francesc Vigues, and Alberto Breda Alessio PecoraroAlessio Pecoraro , Begoña EtcheverryBegoña Etcheverry , Josep Maria GayaJosep Maria Gaya , Angelo TerritoAngelo Territo , Andrea GallioliAndrea Gallioli , Camille BerquinCamille Berquin , Giuseppe BasileGiuseppe Basile , Pietro DianaPietro Diana , Thomas PrudhommeThomas Prudhomme , Nicolas DoumercNicolas Doumerc , Francesc ViguesFrancesc Vigues , and Alberto BredaAlberto Breda View All Author Informationhttps://doi.org/10.1097/01.JU.0001010048.21113.99.05AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney transplant (KT) candidates are fragile and immunocompromised patients and they are more often older, with several comorbidities. However, some of them present a retained iliac fossa from a previous KT or for severe atherosclerotic calcification. In this challenging setting, KT recipients and particularly those patients who are candidates for an orthotopic KT, could benefit the most from the implementation of minimally invasive approach, potentially improving the recipient vessels dissection and the vascular anastomoses, as well as perioperative outcomes. In this video, we report the largest experience about orthotopic robot-assisted KT (ORAKT), focusing on technical nuances and perioperative outcomes. METHODS: We retrospectively collected data regarding patients who underwent ORAKT between January 2020 and August 2023 at three European referral transplant centers. All ORAKTs were performed by a highly experienced robotic and transplant surgeon. The primary aim was to assess the technical feasibility and safety. RESULTS: Overall, 16 ORAKTs were included. Of these, 4 (25%) were from donors after cardiocirculatory death, 5 (31%) from donors after brain death and 7 (44%) from living donors. Notably, all KT were carried out in the left renal fossa. Severe calcification of the external iliac vessels (100%), often with a previous iliac fossa KT (31%), drove ORAKT. The median recipient age was 66 (IQR 63–71) years and the median BMI was 26 (23–29) kg/m2. Surgical open conversion occurred in 12.5% of cases with a median operative time of 295 (268-360) minutes. An end-to-end anastomosis between graft artery and native left renal artery was performed in 75%, while 25% had an end-to-end anastomosis with the splenic artery. Graft vein anastomosed with the native renal vein in all cases. A uretro-ureteral anastomosis was reported in 81% of cases, while pyelo-ureteral anastomosis and ureteral reimplantation were carried out in 2 and 1 case, respectively. During the first 30-days after ORAKT, any grade postoperative complications were recorded in 11 (69%). Of these, 3 patients experienced high- grade complications (Clavien-Dindo >2). CONCLUSIONS: This study presents the largest ORAKT series reported, suggesting the robotic approach offers a safe minimally invasive alternative for select patients unsuitable for heterotopic KT in high-volume KT centers with robotic expertise and prior heterotopic RAKT experience. Robotic surgery can reduce perioperative complications, postoperative pain, and hospital stays while enabling precise dissection of the native renal vein and splenic artery and accurate vascular anastomoses. Source of Funding: None © 2024 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 211Issue 5SMay 2024Page: e377 Advertisement Copyright & Permissions© 2024 by American Urological Association Education and Research, Inc.Metrics Author Information Alessio Pecoraro More articles by this author Begoña Etcheverry More articles by this author Josep Maria Gaya More articles by this author Angelo Territo More articles by this author Andrea Gallioli More articles by this author Camille Berquin More articles by this author Giuseppe Basile More articles by this author Pietro Diana More articles by this author Thomas Prudhomme More articles by this author Nicolas Doumerc More articles by this author Francesc Vigues More articles by this author Alberto Breda More articles by this author Expand All Advertisement PDF downloadLoading ...