Robot-assisted Kidney Autotransplantation: A Minimally Invasive Way to Salvage Kidneys

Decaestecker, Karel; Parys, Benjamin Van; Besien, Jeroen Van; Doumerc, N.; Desender, Liesbeth; Randon, Caren; Ryck, Frédéric De; Tailly, Thomas; Beysens, Matthias; Haute, Carl Van; Ponette, Diederik; Man, Kathia De; Vermassen, Frank

doi:10.1016/j.euf.2018.07.019

Cited by 35 publications

(77 citation statements)

References 27 publications

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“…Decaestecker et al published their initial experience on 7 patients [53], updated their results of the first 10 cases at EAU 2019 congress [54], and now performed 15 cases, making this the largest reported series worldwide. Thirteen cases were performed extracorporeally and two intracorporeally.…”

Section: Resultsmentioning

confidence: 99%

“…In 2017, Araki et al [52] published a case using this extracorporeal RAKAT technique in a patient with proximal ureteral stenosis. Also in 2017, Decaestecker et al [53] performed the first extracorporeal RAKAT in Europe and to date have the largest series of RAKAT worldwide. This European series also adopted a totally intracorporeal technique.…”

Section: History and Backgroundmentioning

confidence: 99%

“…Decaestecker et al published the largest series of RAKAT worldwide, all for non-oncological cases [53]. Their technique is based on the experience within the ERUS-RAKT working group, as described by Breda et al [16], and on the theoretical report by Sood et al [51].…”

Section: Operative Techniquementioning

confidence: 99%

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Robot-Assisted Kidney Transplantation

Decaestecker¹,

Territo²,

Campi³

et al. 2020

Medical Robotics - New Achievements

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Robot-assisted kidney transplantation (RAKT) has recently been introduced to reduce the morbidity of open kidney transplantation (KT). Robot-assisted surgery has been able to overcome many of the limitations of classical laparoscopy, certainly in complex and technically demanding procedures, such as vascular and ureteral anastomosis. Since the first RAKT in 2010, this technique has been standardized and evaluated in highly experienced robot and KT centers around the world. In Europe, the European Association of Urology Robotic Urology Section (ERUS) created an RAKT working group in 2016 in order to prospectively follow the outcomes of RAKT. When performed by surgeons with both robotic and KT experience, RAKT has been proven to be safe and reproducible in selected cases and yield excellent graft function with a low complication rate. Multiple institutions have now adopted RAKT, and its use will likely increase in the near future. However, structured training and proctoring will be mandatory for those embarking on RAKT in order to help them negotiate the learning curve and avoid technical mistakes. This chapter will describe RAKT from living and deceased donors and its application in kidney autotransplantation (KAT).

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Section: Resultsmentioning

confidence: 99%

Section: History and Backgroundmentioning

confidence: 99%

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Robot-Assisted Kidney Transplantation

Decaestecker¹,

Territo²,

Campi³

et al. 2020

Medical Robotics - New Achievements

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“…With laparoscopic nephrectomy before open reimplantation, the kidney can be removed and reimplanted through 1 pelvic incision, thus reducing morbidity (3). Furthermore, both nephrectomy and reimplantation can be performed robotassisted, with only one peri-umbilical mini-laparotomy for a GelPOINT R (AppliedMedical Resources Corp, Rancho Santa Margarita, CA, USA) trocar to remove and re-introduce the kidney (4). If no bench surgery of the kidney or renal vessels is needed and cold ischemia can be established intra-abdominally, total intracorporeal robot-assisted KAT (tiRAKAT) is feasible, as was demonstrated in 3 case reports so far (5)(6)(7).…”

Section: Discussionmentioning

confidence: 99%

Total Intracorporeal Robot Kidney Autotransplantation: Case Report and Description of Surgical Technique

et al. 2020

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Introduction and Objectives: Kidney autotransplantation can be performed in patients with complex renal or ureteral pathology not suitable for in situ reconstruction, such as renal vasculature anomalies, patients with proximal or long complex ureteral strictures, or complex oncological cases. Robot-assisted surgery allows for a high-quality vascular and ureteral anastomosis and faster patient recovery. Robot-assisted kidney autotransplantation (RAKAT) is performed in two phases: nephrectomy and pelvic transplantation. In-between, extraction of the kidney allows for vascular reconstruction or kidney modification on the bench and safe cold ischemia can be established. If no bench reconstruction is needed, total intracorporeal RAKAT (tiRAKAT) is feasible. One case report in Europe has been described; however, to our knowledge no surgical video is available.Methods: A 58 year-old woman suffered from right mid- and distal ureteral stenosis following pelvic radiotherapy 10 years prior for cervical cancer. A JJ stent was placed, but she suffered from recurrent urinary tract infections, and ultimately a nephrostomy was placed. Renogram demonstrated 43% relative right kidney function. As her bladder volume was low following radiotherapy, no Boari flap was possible and the patient refused life-long nephrostomy or nephrectomy. Therefore, tiRAKAT was performed using the DaVinci Xi system.Results: We describe our surgical technique including a video. Surgical time (skin-to-skin) was 5 h and 45 min. Warm ischemia time was 4 min, cold ischemia 55 min, and rewarming ischemia 15 min. The abdominal catheter and bladder catheter were removed on the first and second postoperative day, respectively. The JJ stent was removed after 4 weeks. The patient suffered from pulmonary embolism on the second postoperative day, for which therapeutic low molecular weight heparin was started. No further complications occurred during the first 90 postoperative days. After 7 months, overall kidney function remained stable, right kidney function dropped non-significantly from 27 to 25.2 mL/min (−6.7%) on renal scintigraphy.Conclusion: We demonstrated feasibility and, for the first time, a surgical video of tiRAKAT highlighting patient positioning, trocar placement, and intracorporeal cold ischemia technique.

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“…We would like to stress that tiRAKAT should only be performed by surgeons with experience in robotic renal, vascular, and transplant surgery. Also, because of the specifics of KAT, we would suggest surgeons starting with robotic KAT to perform the first cases with a mini-laparotomy and GelPOINT R for specimen extraction as described previously (4). This will allow proper cold ischemia on the bench.…”

Section: Discussionmentioning

confidence: 99%

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Robot-assisted Kidney Autotransplantation: A Minimally Invasive Way to Salvage Kidneys

Cited by 35 publications

References 27 publications

Robot-Assisted Kidney Transplantation

Robot-Assisted Kidney Transplantation

Total Intracorporeal Robot Kidney Autotransplantation: Case Report and Description of Surgical Technique

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