Robotic assisted kidney auto‐transplantation as a safe alternative for treatment of nutcracker syndrome and loin pain haematuria syndrome: A case series report

Abstract

Background Describe the outcomes and safety of robotic‐assisted kidney auto‐transplantation (RAKAT) in the treatment of nutcracker syndrome (NCS) and loin pain haematuria syndrome (LPHS). Methods This retrospective study included 32 cases of NCS and LPHS seen during December 2016 to June 2021. Results Three (9%) patients had LPHS and 29 (91%) NCS. All were non‐Hispanic whites, and 31 (97%) women. The mean age was 32 years (SD = 10) and the BMI 22.8 (SD = 5). The RAKAT was completed in all patients, 63% had a total improvement of pain. According to the Clavien‐Dindo classification, 47% presented with type 1, and 9% with type 3 complications with a mean follow‐up of 10.9 months. The incidence of acute kidney injury in post‐procedure was 28%. No one required blood transfusions, and there were no deaths during the follow‐up. Conclusion RAKAT was a feasible procedure with a similar complication rate to those reported for other surgical techniques.

Therapeutic Donor Kidney Transplant Outcomes: Comparing Early US Experiences Using Optimal Matching

“…4 Indications for kidney autotransplantation include renovascular disease, ureteral stricture and trauma, excisable malignancy in the kidney and/or urinary tract, and loin pain hematuria syndrome. [14][15][16][17][18][19][20] The kidney failure rate with autotransplantation is approximately 10%. [19][20][21] However, success rates differ between underlying diseases, with loin pain hematuria syndrome having the highest autotransplant graft success rate of 92%-100%, presumably because of the lack of structural abnormalities.…”

Current status and future perspectives on robot‐assisted kidney autotransplantation: A literature review

“…11,20 Table 2 shows a summary of the literature on the indications for RAKAT. [8][9][10][11][12][13][14][15][16][17][18][19] To the best of our knowledge, a total of 86 cases were previously reported of heterotopic RAKAT, and no cases undergoing orthotopic RAKAT were reported. Current indications for RAKAT seem to be comparable to those of conventional laparoscopic approaches.…”

“…Current indications for RAKAT seem to be comparable to those of conventional laparoscopic approaches. As a renal vein disease, NCS has accounted for the largest number of cases (n = 34), 8,[15][16][17]19 of which 29 were derived from a single case series reported by Mejia et al 17 In ureter-related causes, especially ureteral stricture or stenosis (n = 31) were the second most common indication. The causes of ureteral stricture or stenosis were as follows: procedural complications (n = 8) [8][9][10][11]19 ; trauma (n = 1) 8 ; pelvic radiotherapy for cervical cancer (n = 1) 14 ; and unknown causes (n = 2).…”

“…A total of 11 patients underwent RAKAT for LPHS. 8,16,17 A few reports on RAKAT were available for renal artery diseases 13,16 and stone-related causes. 18 Oncological settings for KAT have been previously described in detail 7,21,22 ; however, to the best of our knowledge, there seem to be very few reports on RAKAT for oncological conditions to date.…”

“…16 Then in 2023, Mejia et al described a case series of 32 patients (29 with NCS and 3 with loin pain hematuria syndrome [LPHS]). 17 Thirty patients underwent contralateral and 2 underwent ipsilateral RAKAT. In 2021 and 2023, Kaouk and colleagues reported on the use of the da Vinci single-port system (Intuitive Surgical, Sunnyvale, California, U.S.) for RAKAT in a series of patients.…”