Robotic Assisted transplant graft Nephrectomy

This is  a Runner-up video from the KS National Robotic Surgery Awards, 2019, presented at the Robotic Surgeons Council of India meetings.

Title: Robotic Assisted transplant graft Nephrectomy

Duration: 7 minutes 56 seconds

Authors: Kishore TA , Sunil Bhat, Himanshu Sharma, Gregory Pathrose, Vishnu R

Address for correspondence: Dr Kishore TA; Department of Urology, Aster Medcity, Cheranallore, Ernakulam 682027

Introduction: Transplant Graft nephrectomy is considered a challenging operation because of extensive adhesions and scar tissue formation. Minimally invasive nephrectomy has not been reported in the laparoscopic era. There has been only one report of Robotic graft nephrectomy till now.¹ We present our experience of Robotic Assisted Transplant Graft Nephrectomy.

Materials & methods: 40-year-old male a prospective second renal transplant candidate with chronic rejection and recurrent pyelonephritis was taken up for graft nephrectomy. A Da Vinci Si system (Intuitive Surgical, Sunnyvale, CA, USA) and 5 ports similar to robotic renal transplant was used. The peritoneum was incised at the superior aspect of graft, gonadal vessel encountered were divided. Since the graft was anastomosed to external iliac vessels previously, the proximal control of external iliac artery was obtained. The kidney was then mobilized in the inferior aspect and distal control of external iliac artery was also obtained. Subsequently renal artery was identified and ligated. The renal vein was divided and suture ligated with 6.0 Gore-Tex suture (Gore, AZ, USA). The pelvis was transected and preplaced DJ stent was extracted out.  Finally, nephrectomy was completed and the kidney was placed in an endobag and extracted out extending the port site.

Results & Observations: The total operative time was 215 minutes, console time was 170 minutes, blood loss was 50 ml. Patient was discharged 3^rd postoperative day. Patient underwent Robotic assisted kidney transplant 5 weeks later with placement of graft on left side.

Conclusions: Robotic assistance makes the transplant graft nephrectomy easier proposition compared to open. This will allow early recovery and reduced hospital stay. It will also avoid wound complications such as wound infection and hernia

References: Mulloy MR, Tan M, Wolf JH, D’Annunzio SH, Pollinger HS. Robotic trans-abdominal transplant nephrectomy for a failed renal allograft. Am J  Transplant. 2014 Dec;14(12):2883-6.; Conflictofinterest: None

Authors have received and archived patient consent for video recording/publication in advance of video recording of procedure. Robotic Surgery video, with MRI’s, photos, narrated,  07:56.