[Retracted] Results and Lessons Learned on Robotic Assisted Kidney Transplantation

Abstract

Introduction. Nowadays, minimally invasive surgery in kidney transplantation is a reality thanks to robotic assistance. In this paper, we describe our experience, how we developed the robotic assisted Kidney transplantation (RAKT) technique, and analyze our results. Material and Methods. This is a retrospective study of all RAKTs performed at our center between July 2015 and March 2020. We describe the donor selection, surgical technique, and analyze the surgical results and complications. A comparison between the first 20 cases and the following ones is performed. Results. During the aforementioned period, 82 living donor RAKTs were performed. The mean age was 47.4±13.4 and 50 (61%) were male. Mean body mass index was 25±4.7 and preemptive in 63.7% of cases. Right kidneys and multiple arteries were seen in 14.6% and 12.2%, respectively. Mean operative and rewarming time was 197±42 and 47±9.6 minutes, respectively. Five cases required conversion to open surgery because of abnormal kidney vascularization. Two patients required embolization for subcapsular and hypogastric artery bleeding without repercussion. Three kidneys were lost, two of them due to acute rejection and one because venous thrombosis. Late complications requiring surgery included one kidney artery stenosis, one ureteral stenosis, two lymphoceles, and three hernia repairs. We noticed a significant reduction in time between the first 20 cases and the following ones from 248.25±38.1 to 189.75±25.3 (p<0.05). With a mean follow-up time of 1.8 years (SD 1.3), the mean creatinine was 1.52 (SD 0.7) and RAKT graft survival was 98%. Conclusions. The robotic approach is an attractive, minimally invasive method for kidney transplantation, yielding good results. Further studies are needed to consider it a standard approach.

Robot-assisted kidney transplantation: an update

“…The ERUS–RAKT group [ 42 ] is currently the largest international collaborative on RAKT, with 10 centres across Europe maintaining a prospective dataset of >300 patients undergoing RAKT [ 35 ]. Their recent update demonstrates good surgical and functional results, comparable with those of OKT [ 47 ].…”

“…From a physiological standpoint, the pneumoperitoneal injury in recipient surgery is only experienced after reperfusion of the graft. While some groups report no effect of pneumoperitoneum on early graft function [ 41 ], some RAKT groups routinely reduce the intra-abdominal pressures to 10 mmHg [ 47 , 68 ] and even use a retroperitoneal approach [ 38 ] in an effort to reduce the deleterious effects of higher pressures on graft function. The Trendelenburg position (head down and elevation of the feet) used in RAKT can predispose the patient to head and neck oedema, including cerebral, tracheal and optic oedema [ 69–71 ].…”

“…Therefore studies aiming to evaluate this LC set out to define the number of sequential procedures required to overcome the LC [ 74 , 75 ]. The reported LC of RAKT is relatively short, with studies suggesting 20–35 cases are required to achieve operative and graft rewarming times competitive with those of OKT [ 47 , 76 , 77 ]. While the LC is currently assessed by time, it is suggested that neither total operative nor rewarming times correlate with post-operative serum creatinine levels at 7 and 30 days post-operatively or at the 1-year follow-up [ 77 ].…”

Living Kidney Donation: Practical Considerations on Setting Up a Program

“…Recommended approaches are, therefore, mini-open, laparoscopy (full or hand-assisted), and retroperitoneoscopy [24,25]. More recently, robotic-assisted living donor nephrectomy has been showing the best outcomes in the prevention of excessive manipulation of the kidney during the extraction, but there is a higher overall cost, thus significantly limiting its implementation [26].…”

Results of the 50 First Cases of Robotic assisted Kidney Transplantation compared with Matched-pair Open Cases- A Retrospective Cohort Study

“…For instance we changed the perfusion solution from Ringer's lactate to Celsior, because a slow reduction in post RAKT creatinine levels has been noticed in the first cases what were performed in our enter. We reduced pneumoperitoneum pressure from 12 to 10mmHg after graft reperfusion to reduce possible graft damage [9,10]. Kidney was introduced through a periumbilical incision at the beginning of the series, and later on we changed to a pfannenstiel incision that permits a quick open conversion if necessary.…”