Innovative Applications of Robotic Surgery: Renal Allograft and Autologous Transplantation

Abstract

Robotic surgery has enabled surgeons to offer more patients a minimally invasive surgical option in the management of their complex diseases. While renal transplantation is associated with significant improvements in quantity and quality of life for most end-stage renal disease (ESRD) patients, it is also not devoid of its surgical risks and potential morbidities. Robotic-assisted kidney transplantation is a recently described, innovative application of the robotic surgery platform, and early experiences suggest that it is associated with comparable graft function and lower rates of complications.Urinary tract obstruction, though less common than ESRD, can be a serious threat to renal function. Severe ureteric stricture disease can represent a clinically complex problem requiring major reconstructive surgery. Completely intra-corporeal robotic renal auto-transplantation is another innovative application of the robotic surgery platform and represents a significant advancement in urologic surgery. Initial reports of this procedure demonstrate safety, feasibility, and excellent renal function outcomes.

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

“…However, the procedure can be technically challenging and requires intracorporeal preparation, perfusion, and requires careful control of the temperature of the graft. 16,36 With the ability to provide high-quality vascular and ureteral anastomoses and a reliably functional autotransplanted graft, RAKAT is a promising alternative for patients with various conditions such as obesity and complex renovascular diseases. 8,14 As the technology improves, the advantages of RAKAT should become even more evident.…”

“…Robotic procedures are associated with a relatively less steep learning curve than pure laparoscopic procedures. 36 Ahlawat et al 37 and Gallioli et al 38 have stated that surgeons need experience with at least 21 or 35 cases, respectively, to perform RAKAT independently and reproducibly, particularly with the optimization of ischemia times. It is especially important that overall improvement in operative times can be attained by accelerating the learning curve 19 and thus increasing the number of RAKAT cases.…”

“…If both the donor nephrectomy and KAT are performed by minimally invasive surgical techniques while the autograft is maintained intracorporeally, the morbidity of large skin incisions can be avoided. However, the procedure can be technically challenging and requires intracorporeal preparation, perfusion, and requires careful control of the temperature of the graft 16,36 . With the ability to provide high‐quality vascular and ureteral anastomoses and a reliably functional autotransplanted graft, RAKAT is a promising alternative for patients with various conditions such as obesity and complex renovascular diseases 8,14 .…”

“…However, the operative time should improve with continuous use of the robotic systems. Robotic procedures are associated with a relatively less steep learning curve than pure laparoscopic procedures 36 . Ahlawat et al 37 .…”

Anesthetic Management of a Patient Undergoing Robotic Assisted Renal Transplant

“…Robotic assistance for renal transplant is a new technique and gives dexterity in fine movements required for the complex anastomosis of renal transplant without the need of opening the abdomen [1,2]. This leads to less surgical morbidity and decrease in hospital stay with similar patient and graft survival [2].…”