RESULTSThe site of the urethral arteries in 'normal' men varied among individuals; they were at the 10-2 o'clock position in six men, 8-10 o'clock and 2-4 o'clock in six, and at the 4-8 o'clock position in three. In normal men the symmetry of arteries was maintained and the mean distance from the lumen was 2.67 mm. In men with urethral stricture, there was a loss of symmetry in all cases. In a dense stricture the urethral arteries could not be detected on either side in three of cases, while only a single artery was seen in three. In two men, both the arteries were on one side. The mean distance of the urethral artery from the lumen of urethra was 1.88 mm.
TERT is a technically demanding procedure that closely resemble open technique while imparting the benefits of minimally invasive surgery to the patient.
The aim of the study is to elucidate the method of complete extraperitonealization of the graft while performing transperitoneal robotic renal transplant recipient operation. This is a retrospective study of 34 robotic-assisted kidney transplant (RAKT) utilizing our technique from July 2015 to June 2017. The study is performed in a quaternary private hospital setting. The surgery was performed using our novel peritoneal flap technique allowing complete extraperitonealization of the kidney. Total of 34 patients underwent RAKT in our hospital. Mean age was 40.6 ± 8.1 years, there were 25 males and 9 females. 30 had single vessel and four had double vessels. 27 patients received living donor graft while seven had deceased donor. The mean blood loss was 88 ± 51 mL, mean anastomotic time was 32 ± 3.3 min, mean total operative time was 145 ± 15 min, mean hospital stay was 5.8 ± 2.3 days, time to nadir creatinine was 4.3 ± 1.9 days, median creatinine level at the end of 6 months was 1.3 mg/dL. There were three open conversions in our series, one of which had delayed graft function requiring hemodialytic support. Total extraperitonealization of the graft reproduces closely the technique of open kidney transplant with good graft function. This would be a step toward the ultimate goal of performing a complete extraperitoneal robotic transplant. Further refinements in robotic instruments would make this a reality in near future.
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