Feasibility and technical nuances of Robotic Kidney Transplant (RKT) with graft placement in the left iliac fossa

A KS Robotic Surgery Awards entry:

Feasibility and technical nuances of Robotic Kidney Transplant (RKT) with graft placement in the left iliac fossa

Feroz Amir Zafar, Tarun Jindal, Indraneel Banerjee, Ashwin Mallya, Sachin Arakere, Rohan Nautyal, Rajesh Ahlawat

Abstract:

Introduction: Robotic Kidney Transplant (RKT) has been found to achieve comparable functional outcomes with open kidney transplant (OKT) with the added minimally invasive benefits and lower vascular and wound related complications. The technique of RKT has been described earlier with graft placement in the right iliac fossa. The video demonstrates the feasibility and technical nuances of doing kidney transplant robotically with placement of graft in the left iliac fossa.

Material and Methods: A retrospective analysis of patients who underwent RKT at our institution from June 2016-August 2017 was performed. The patients who had a left sided transplant were identified from this cohort. The time taken for bed preparation, venous anastomosis, arterial anastomosis, total ischemia time, total console time, and mean creatinine values at discharge were compared with those who had a right sided RKT.

Results: 148 patients underwent RKT between June 2016 and August 2017 out of which 71 had RKT and 77 had OKT. 11 patients had the graft kidney placed in the left iliac fossa. The parameters evaluated were comparable between both the groups. The bed preparation time (mins) in the right and left iliac fossa group were 18.72 (+/-5.9) and 17.2(+/-1.92), Venous anastomosis time(mins) were 12.9(+/-2.48) and 13.4(+/-2.07), Arterial anastomosis time(mins) were 12.07(+/-2.78) and 13.6+/-2.19, console time(mins) was 149.45+/-15.71 and 156.2+/-16.39, total ischemia time(mins) was 74.35(+/-14.93) and 78.65(+/-16.68) respectively. The mean creatinine (mg/dl) at discharge was 1.31(+/-0.61) in right iliac fossa group compared to 1.33(+/-0.65) in the left iliac fossa group. However, the technique of retroperitonealization differed on the two sides.

Conclusions: RKT in the left iliac fossa is technically feasible and the outcomes are similar to those undergoing a conventional right iliac fossa RKT.

Narrated robotic surgery video, with PPT’s, photos and robotic surgery video clips, 07:42