Robotic renal transplantation: first European case

Boggi, Ugo; Vistoli, Fabio; Signori, S; D’Imporzano, S; Amorese, G; Consani, G; Guarracino, Fabio; Melfi, Franca; Mussi, Alfredo; Mosca, Franco

doi:10.1111/j.1432-2277.2010.01191.x

Cited by 105 publications

(71 citation statements)

References 29 publications

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“…To our knowledge, this is the first reported attempt to analyze key factors of this procedure in a preclinical setting. Groups who first performed this procedure in patients did not report previous in vivo experimental attempts 9, 10, 16. A first important difference that we observed was the increase of the anastomosis time in the robot‐assisted transplantation group.…”

Section: Discussionmentioning

confidence: 77%

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Meier

Piller

Hagen

et al. 2018

American Journal of Transplantation

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Robot‐assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra‐abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra‐abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p‐values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia–reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot‐assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra‐abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia–reperfusion injuries.

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Section: Discussionmentioning

confidence: 77%

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Meier

Piller

Hagen

et al. 2018

American Journal of Transplantation

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“…The main limitations of current dVss are lack of haptic feedback, high cost, risk of technical failure, poor adaptability to multiquadrant surgery, and loss of direct contact between surgeon and patient [10].…”

Section: Discussionmentioning

confidence: 99%

“…Other main drawbacks are risk of technical failure, loss of direct contact between surgeon and patient, and poor adaptability to multi-quadrant surgery [10].…”

Section: The Da Vinci Surgical Systemmentioning

confidence: 99%

Current Perspectives on Laparoscopic Robot-Assisted Pancreas and Pancreas-Kidney Transplantation

Boggi¹,

Signori²,

Vistoli³

et al. 2011

Rev Diabet Stud

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■ AbstractPancreas transplant recipients continue to suffer high surgical morbidity. Current robotic technology provides a unique opportunity to test whether laparoscopy can improve the post-operative course of pancreas transplantation (PT). Current knowledge on robotic pancreas and renal transplantation was reviewed to determine feasibility and safety of robotic PT. Information available from literature was included in this review, together with personal experience including three PT, and two renal allotransplants. As of April 2011, the relevant literature provides two case reports on robotic renal transplantation. The author's experience consists of one further renal allotransplantation, two solitary PT, and one simultaneous pancreas-kidney transplantation. Information obtained at international conferences include several other renal allotransplants, but no additional PT. Preliminary data show that PT is feasible laparoscopically under robotic assistance, but raises concerns regarding the effects of increased warm ischemia time on graft viability. Indeed, during construction of vascular anastomoses, graft temperature progressively increases, since maintenance of a stable graft temperature is difficult to achieve laparoscopically. There is no proof that progressive graft warming produces actual damage to transplanted organs, unless exceedingly long. However, this important question is likely to elicit a vibrant discussion in the transplant community.

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“…With no available ideal cooling technique, some laparoscopic or roboticassisted kidney transplants have been experimentally or clinically performed under warm ischemia conditions without additional renal graftcooling procedures by some professors who anticipate that this issue will be extensively debated, and who expects it to provide new impetus to research. 4,7,9,10 In the series by Meraney, intracorporeal hypothermia was achieved by intra-arterial perfusion of ice-cold solution through a 4-F balloon catheter, 3 but the possible risks of vascular injury and issues of technical complexity were its drawbacks. Rosales and associates reported that renal hypothermia was maintained by means of ice and continuous transcutaneous irrigation with cold saline solution in their laparoscopic kidney transplant.…”

Section: Discussionmentioning

confidence: 99%

“…[8][9][10][11] The hindrance in laparoscopic kidney transplant is not only that of technical demand, but also of intraoperative renal hypothermia, which has not yet been solved. On the other hand, the reported cases of laparoscopic or robot-assisted kidney transplant were performed heterotopically into the iliac fossa.…”

Section: Introductionmentioning

confidence: 99%

Comparison of 2 Devices in Pigs To Induce Hypothermia in Laparoscopic Orthotopic Kidney Transplant

Han

Bao²,

Yan³

et al. 2012

Exp Clin Transplant

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Objectives: To laparoscopically compare the effectiveness of 2 cooling devices for renal hypothermia and investigate the feasibility of laparoscopic orthotopic kidney transplant using a pig model. Materials and Methods: Eight pigs were divided into 2 groups of 4 animals each. Laparoscopic nephrectomy and autotransplant were performed first on only the right kidney. One week later, these procedures were performed on the left kidney, while the first transplanted autograft was removed. After 1 more week, the left autograft was removed for observation. In 1 group, the silicon tube cage was used to induce hypothermia during laparoscopic orthotopic kidney transplant (silicon tube cage group), and in the other group, the plastic bag jacket was used to induce hypothermia during laparoscopic orthotopic kidney transplant (plastic bag jacket group). Results: Two pigs in the silicon tube cage group survived for 7 days after the second autotransplant with serum creatinine levels of 210 µmol/L and 1010 µmol/L. One pig in the plastic bag jacket group survived for 5 days. The mean surface temperature of the grafts was maintained at 9°C ± 3°C and 12°C ± 3°C in the silicon tube cage and plastic bag jacket groups (P = .166). Three of 6 plastic bag jacket devices were ruptured by stitches or instruments. The mean venous and arterial anastomotic times in the silicon tube cage group were significantly shorter than were those in the plastic bag jacket group. Conclusions: Our study shows that the silicon tube cage may be a reliable renal cooling device for use in laparoscopic kidney transplant and indicates the feasibility of laparoscopic orthotopic kidney transplant in pigs.

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Robotic renal transplantation: first European case

Cited by 105 publications

References 29 publications

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Intra-Abdominal Cooling System Limits Ischemia–Reperfusion Injury During Robot-Assisted Renal Transplantation

Current Perspectives on Laparoscopic Robot-Assisted Pancreas and Pancreas-Kidney Transplantation

Comparison of 2 Devices in Pigs To Induce Hypothermia in Laparoscopic Orthotopic Kidney Transplant

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