Initial Experience with Single-port Robotic-assisted Kidney Transplantation and Autotransplantation

Kaouk, Jihad; Eltemamy, Mohamed; Aminsharifi, Alireza; Schwen, Zeyad; Wilson, Clark A.; Zeinab, Mahmoud Abou; Lenfant, Louis; Wee, Alvin

doi:10.1016/j.eururo.2021.03.002

Cited by 23 publications

(39 citation statements)

References 33 publications

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“… 14 , 17 Other studies have reported successes performing SP robotic pyeloplasty, kidney transplantation, and autotransplantation. 18 , 19 Takeaways from these series have highlighted advantages with the SP ranging from technical aspects like greater ease with intracorporeal instrumentation and superior camera control, to clinical outcomes like low pain scores and potentially decreased narcotic prescriptions. The SP system has also been successfully utilized to perform radical cystectomy 20 and prostatectomy, 21 offering a broader look at how this technology can be leveraged in urologic surgery.…”

Section: Discussionmentioning

confidence: 99%

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Garden¹,

Al-Alao²,

Razdan³

et al. 2021

JSLS

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Objectives: The da Vinci SP® Surgical System received U.S. Food and Drug Administration approval for urological procedures in 2018. Here, we describe the first experience performing single-port robot-assisted donor nephrectomy (RADN) using the da Vinci SP® surgical system, present 90-day clinical outcomes, and discuss tips for operative success. Methods: Seven consecutive patients underwent single-port RADN at a single institution between September 1, 2020 and March 31, 2021. Surgery was performed through a single, 60 mm Pfannenstiel incision with a 12 mm periumbilical assistant port for suction and vascular stapling. Donor characteristics, operative details, 90-day donor clinical outcomes, and recipient renal function were retrospectively evaluated. Results: Four female and three male patients successfully underwent single-port RADN without conversion to standard multiport or open approach. Six cases were left-sided. Estimated blood loss for each procedure was ≤ 50 mL. Mean operative time, warm ischemia time, and extraction time were 218.3 minutes (standard deviation [SD]: 16.3 minutes), 5 minutes 4 seconds (SD: 56 seconds), and 3 minutes 37 seconds (SD: 38 seconds). Mean pre-operative creatinine and estimated glomerular filtration rate were 0.79 mg/dL and 107.3 mL/min/1.73m 2 , respectively. At six week’s follow up, they were 1.22 mg/dL and 66.1 mL/min/1.73m 2 . Average pain score at 48 hours postoperatively was 1.7/10. There were no Clavien-Dindo grade ≥ III complications within 90 days. All recipients experienced immediate and sustained return of renal function post-transplant. Conclusion: Single-port RADN is a technically feasible and safe procedure with the da Vinci SP® system and can confer acceptable functional and cosmetic outcomes. Future studies are needed to define long-term outcomes and compare with previously established techniques for donor nephrectomy.

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Section: Discussionmentioning

confidence: 99%

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Garden¹,

Al-Alao²,

Razdan³

et al. 2021

JSLS

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“…Recently, robotic repair has been proposed as a safe option in the management of UES after RARC [ 7 , 13 ]. A single-port platform has been successfully introduced in three cases [ 14 ]. However, evidence is scarce on this topic, particularly in cases of bilateral severe strictures longer than 3 cm.…”

Section: Discussionmentioning

confidence: 99%

Successful Multidisciplinary Repair of Severe Bilateral Uretero-Enteric Stricture with Inflammatory Reaction Extending to the Left Iliac Artery, after Robotic Radical Cystectomy and Intracorporeal Ileal Neobladder

et al. 2021

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Uretero-enteric anastomotic strictures (UES) after robot-assisted radical cystectomy (RARC) represent the main cause of post-operative renal dysfunction. The gold standard for treatment of UES is open uretero-ileal reimplantation (UIR), which is often a challenging and complex procedure associated with significant morbidity. We report a challenging case of long severe bilateral UES (5 cm on the left side, 3 cm on the right side) after RARC in a 55 years old male patient who was previously treated in another institution and who came to our attention with kidney dysfunction and bilateral ureteral stents from the previous two years. Difficult multiple ureteral stent placement and substitutions had been previously performed in another hospital, with resulting urinary leakage. An open surgical procedure via an anterior transperitoneal approach was performed at our hospital, which took 10 h to complete, given the massive intestinal and periureteral adhesions, which required very meticulous dissection. A vascular surgeon was called to repair an accidental rupture that had occurred during the dissection of the external left iliac artery, involved in the extensive periureteral inflammatory process. Excision of a segment of the external iliac artery was accomplished, and an interposition graft using a reversed saphenous vein was performed. Bilateral ureteroneocystostomy followed, which required, on the left side, the interposition of a Casati-Boari flap harvested from the neobladder, and on the right side a neobladder-psoas-hitching procedure with intramucosal direct ureteral reimplantation. The patient recovered well and is currently in good health, as determined at his recent 24-month follow-up visit. No signs of relapse of the strictures or other complications were detected. Bilateral ureteral reimplantation after robotic radical cystectomy is a complex procedure that should be restricted to high-volume centers, where multidisciplinary teams are available, including urologists, endourologists, and general and vascular surgeons.

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“…During robotic repair, Tuderti et al highlighted the usefulness of ICG injection via nephrostomy to identify the healthy ureter [42]. Kaouk et al successfully introduced da Vinci SP ® , which is a single port platform, to treat three patients with UES, including one with bilateral UES after cystectomy [43]. Further validation studies on the usefulness of a conventional robotassisted system or a single port robotic system are therefore required for repair of UES, especially for challenging cases with UES.…”

Section: Managementmentioning

confidence: 99%

Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience

et al. 2021

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Benign ureteroenteric anastomosis strictures (UESs) are one of many critical complications that may cause irreversible disability following robot-assisted radical cystectomy (RARC). Previous studies have shown that the incidence rates of UES after RARC can reach 25.3%, with RARC having higher UES incidence rates compared to open radical cystectomy. Various known and unknown factors are involved in the occurrence of UES. To minimize the incidence of UES after RARC, our group has standardized the procedure and technique for intracorporeal urinary diversion by applying the following five strategies: (1) wide delicate dissection of the ureter and preservation of the periureteral tissues; (2) gentle handling of the ureter and security of periureteral tissues at the anastomotic site; (3) use of indocyanine green to confirm good blood supply; (4) standardization of the ample ureteral spatulation length for Wallace ureteroenteric anastomosis through objective measurements; and (5) development of an institutional standardized procedure manual. This review focused on the incidence, etiology, prevention, and management of UES after RARC to bring attention to the incidence of this complication while also proposing standardized surgical procedures to minimize its incidence after RARC.

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Initial Experience with Single-port Robotic-assisted Kidney Transplantation and Autotransplantation

Cited by 23 publications

References 33 publications

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Robotic Single-Port Donor Nephrectomy with the da Vinci SP® Surgical System

Successful Multidisciplinary Repair of Severe Bilateral Uretero-Enteric Stricture with Inflammatory Reaction Extending to the Left Iliac Artery, after Robotic Radical Cystectomy and Intracorporeal Ileal Neobladder

Incidence, Etiology, Prevention and Management of Ureteroenteric Strictures after Robot-Assisted Radical Cystectomy: A Review of Published Evidence and Personal Experience

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