Robotic Assisted Kidney transplantation- Challenges
Robotic Assisted Kidney transplantation- Challenges
This video was a Finalist for the 2019 KS National Robotic Surgery Video Awards, screened and adjudicated at the Robotic Surgeons Council of India meeting. Presented by Dr. Himanshu Sharma. Here is the Abstract:
Introduction:
Robotic assisted kidney transplantation (RAKT) has recently been introduced as a management option for patients with end stage renal disease. While open kidney transplant (OKT) remains the gold standard, RAKT is increasingly being adopted across the world as a technique with equivalent outcomes and lesser complications especially for the obese patient. The challenges encountered during the performance of vascular anastomosis owing to multiple renal vessels and right-sided renal allograft transplant (short renal vein) are potential reasons for non-selection of patients for RAKT as well as open conversion.
Objective:
To demonstrate technical feasibility of robotic assisted kidney transplant in right-sided (with short renal vein) and multiple vessel renal allograft.
Materials and methods:
This is a retrospective study of 22 patients who underwent RAKT with right-sided (04) and multiple vessel (18) renal allografts in a quaternary private hospital setting. The results were compared with 22 OKT patients. All the surgeries were performed by a single surgeon with more than 5 year experience in robotic as well as open transplant. Clinical data were collected in a Microsoft Excel based database. A descriptive statistical analysis was performed.
Surgical Procedure
The techniques used for managing multiple vessel renal allograft were side to side trousering of multiple vessel renal allograft on the bench (5 in RAKT versus 1 in OKT) followed by robotic assisted vascular anastomosis, end to side anastomosis of single renal artery to external iliac artery (8 in RAKT versus 10 in OKT), anastomosis of smaller caliber, accessory renal allograft artery to the inferior epigastric artery (2 in RAKT versus 1 in OKT) and double barreled anastomosis of double vessel renal allograft to two separate arteriotomy incisions made in the external iliac artery (3 in RAKT versus 6 in OKT)
Results:
Total of 44 patients underwent kidney transplant in this study (22 RAKT and 22 OKT). The mean age of the recipients was 37.1±13.2 and 35.2±12.8 years in RAKT & OKT groups respectively. The mean time from clamping to perfusion of the renal allografts was 74±16.3 minutes (RAKT) and 69.4±15.3 minutes in OKT group (p value 0.332). The mean operating time was 165±22 versus 175±33 minutes in RAKT and OKT groups respectively (p value 0.344). The mean hospital stay was 6.71 ± 1.7 (RAKT) versus 7.75 ± 2.3 days (OKT) respectively (p value 0.17) and the time to nadir creatinine was 6.5 ±1.23 days in RAKT group as compared to 5.9 ± 1.1 days in OKT group (p value 0.6). The pain score on day 4 and mean analgesia requirement on postoperative day 1 was significantly lower in the RAKT group as compared to OKT group (p value 0.0004 and 0.02 respectively). The mean incision length was also significantly (p value 0.0001) smaller in the RAKT group (8.2 ± 0.9 cm) as compared to the OKT group (17.1 ± 2.9 cm).
Conclusion:
RAKT is a feasible option for patients receiving right-sided as well as multiple vessel renal allografts and the challenges could be safely overcome by the techniques described.
Robotic surgery videos, with PPT’s, photos and 3-D imaging, Narrated, 07:52
Date
August 15, 2020
