Single-Port Robotic-Assisted Kidney Transplantation and Autotransplantation

Single-Port Robotic-Assisted Kidney Transplantation and Autotransplantation

Journal Scan / Research · April 25, 2021
Single-Port Robotic-Assisted Kidney Transplantation and Autotransplantation
European Urology
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TAKE-HOME MESSAGE
The authors present outcomes following single-port robotic-assisted kidney transplantation in 6 patients who underwent allograft and 3 patients who underwent auto-transplantation. Surgical access involved the use of a 5-cm midline periumbilical abdominal incision through which the allografts were introduced. Operative time ranged from 300 to 450 minutes for allograft transplantation and from 510 to 600 minutes for autotransplant. Renal function outcomes were good in all patients.
The authors report good patient outcomes following single-port robotic-assisted kidney transplantation, suggesting the feasibility and safety of this approach, albeit at the expense of increased operative time.
David A. Goldfarb MD
This article is the beginning of the next chapter for robotic transplantation. Most experience worldwide with robot-assisted kidney transplant (RAKT) has been with a multiport technique using the transperitoneal approach. The authors describe 3 kidney autotransplants and 6 cases of kidney allotransplantation using the single-port robotic platform. All cases were successful with good early function. The extraperitoneal single-port cases better recapitulates the standard open approach (Gibson incision) to transplant. The most meaningful advantages of the single-port RAKT are a more rapid recovery, shorter hospital stay and less narcotic use. Autotransplantation can be facilitated from the same single incision. The allograft patients were selected for favorable vascular anatomy. The allograft donor kidneys were selected for simple anatomy. Understand that one needs substantial experience with the single-port platform to make these successful. By way of technical note, the loss of haptic feedback makes suture and vascular clamp handling trickier. Although initially skeptical about robotic transplant, the train has taken off, and the techniques discussed here may well become tomorrow’s standard.
abstract
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BACKGROUND
Compared with the standard open approach, multiport robotic-assisted kidney transplantation (RAKT) has emerged as a less morbid alternative. The use of a single-port robotic approach for kidney transplantation (KT) is presented in this study as having the potential for further reducing the morbidity of KT.
OBJECTIVE
To present the technique and evaluate perioperative and short-term (≤1 yr) postoperative outcomes of single-port RAKT.
DESIGN, SETTING, AND PARTICIPANTS
Prospective evaluation of peri- and postoperative outcomes in patients who underwent allograft KT (n = 6) or kidney autotransplantation (n = 3). The IDEAL model (www.ideal-collaboration.net/framework) for safe surgical innovation was used.
SURGICAL PROCEDURE
Kidney allografts from living or deceased donors were transplanted into six patients with end-stage renal disease. Single-port robotic surgery was performed through a 5-cm midline periumbilical abdominal incision with transperitoneal or extraperitoneal approaches. With similar incision and technique, the right or left kidney was removed and autotransplantation was performed in three patients.
MEASUREMENTS
Intra- and postoperative variables, and outcomes were assessed with a descriptive analysis.
RESULTS AND LIMITATIONS
Single-port RAKT procedures were completed successfully, with total operative and vascular anastomosis times ranging from 300 to 450 mins and from 52 to 92 mins, respectively. All six patients had excellent graft function with serum creatinine levels at the last follow-up (2 wk to 1 yr), ranging from 1.2 to 1.5 mg/dl. Renal autotransplantation was also completed successfully with a single-port robotic approach in three patients. The total operative and vascular anastomosis times ranged from 510 to 600 mins and from 65 to 83 mins, respectively. In all three cases, serum creatinine levels remained normal after the surgery and during follow-up, and all remained symptom-free at the time of this writing (4–8 mo after their surgeries).
CONCLUSIONS
In this initial experience, single-port RAKT is feasible with potential benefits such as offering true single-site minimally invasive surgery, extraperitoneal approach, less morbidity, and comparable short-term graft functional outcomes.
PATIENT SUMMARY
We presented the initial experience with the application of single-port robotic surgery for kidney transplantation and autotransplantation. This technique was found to be safe and effective, with promising postoperative outcomes and potentially with less morbidity.
Copyright © 2021 Elsevier Inc. All rights reserved.
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