Single Port Robot-Assisted Kidney Transplantation: Extraperitoneal Approach

This is the First Place Winner from the 2022 KS International Robotic Surgery Innovation Awards

ABSTRACT Single Port Robot-Assisted Kidney Transplantation: Extraperitoneal Approach Jihad Kaouk, MD Objective To describe the surgical steps and techniques of single-port robot-assisted extraperitoneal kidney transplantation using the SP da Vinci platform. Methods Patients are placed in the supine position with the bed slightly flexed, tilted toward the left side, and put in a 15° Trendelenburg position. A 5-cm peri or infra-umbilical incision is made and the extraperitoneal space is developed. GelPOINT access platform is placed and the robot is docked. The external iliac artery and vein are carefully dissected. The bench is performed using a LigaSureTM device to dissect the vessels. A ureteral stent is placed and the posterior surfaces of the artery and the vein are marked. The kidney is then wrapped with a blue surgical glove. After introducing some ice and the kidney into the extraperitoneal space, the robot is redocked, and venous and then arterial anastomoses are performed using 6-0 GORE-TEX® sutures. After repositioning the kidney, ureteroneocystostomy is done. Nephropexy is then performed. The robot is undocked and the wound is closed. Results Single-port robot-assisted kidney transplantation has been performed for 12 patients. Allograft kidneys were from living and deceased donors in 9 and 3 patients respectively. There were no perioperative complications. Median (IQR) vein and artery anastomosis times were 26 (24-28) and 37 (33-40) minutes, respectively. All grafts were perfused well on the color Doppler ultrasonography. Mean (SD) follow- up and creatinine were 11.25 (6.3) months, and 1.26 (1.16) mg/dL respectively. Conclusion We described technical aspects of the single-port robotic extraperitoneal kidney transplantation. 8:08 Robotic surgery/ narrated, with PPT’s MRI, Photos.

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