Robot-Assisted Kidney Transplantation

Decaestecker, Karel; Territo, Angelo; Campi, Riccardo; Parys, Benjamin Van; Bevilacqua, Giulio; Desender, Liesbeth; Breda, Alberto

doi:10.5772/intechopen.90276

Cited by 3 publications

(5 citation statements)

References 47 publications

(69 reference statements)

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“…Robotic surgery has renewed interest in KAT, with RAKAT emerging as an alternative treatment option to salvage the kidney in patients with complex renovascular, renal, or ureteral pathology [( 10 ), Van Parys et al, in review]. Often, kidney extraction and bench surgery are necessary, e.g., for vascular reconstruction, lithiasis extraction, or tumor excision.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, through shareddecision making, she opted for autotransplantation. Surgery was performed in September 2019 at Ghent University Hospital by KD, who is experienced in robotic uro-oncological surgery and kidney allo-and autotransplantation (4,10). Surgery was performed with the DaVinci Xi R (Intuitive Surgical, Sunnyvale, CA, USA) system.…”

Section: Case Presentationmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 99%

Section: Case Presentationmentioning

confidence: 99%

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

et al. 2020

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“…Based on our extensive experience in RALS in pediatric urology (24)(25)(26) and robotic kidney transplantation surgery (16,27,28), we decided to initiate a pediatric robot-assisted kidney transplantation program. For the time being, we have limited the program to cases of grafting performed with living donor transplants.…”

Section: Our Experiencementioning

confidence: 99%

“…According to Decaestecker et al (27), it cannot be emphasized enough that a high level of robotic experience is recommended before initiating a RAKT program. Training the technique on both dry and wet lab models is mandatory (27). The only structured RAKT course, provided at ORSI Academy (Melle, Belgium) (40), is recommended.…”

Section: Training and Experiencementioning

confidence: 99%

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Pediatric Challenges in Robot-Assisted Kidney Transplantation

et al. 2021

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Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical–material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.

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