ABSTRACT
Purpose:
To report our institutional technique for robot-assisted kidney transplantation (RAKT) (1, 2) in a detailed, step-by-step manner.
Materials and methods:
This is a case of RAKT from a living donor successfully performed at our institution. A 29-year-old male with end-stage renal disease secondary to focal segmental glomerulosclerosis, undergoing hemodialysis with a baseline serum creatinine of 1035 μmol/L at admission, received a left kidney donated by his 55-year-old mother. Preoperative evaluation confirmed one HLA mismatch (0-0-1) and ABO compatibility, making the patient suitable for living donation.
Results:
The procedure was performed using the da Vinci Xi robotic system (Intuitive, Sunnyvale, CA, USA). The recipient was placed in a 23° Trendelenburg position. Four robotic ports were aligned above the umbilicus, and two additional ports were used for the assistant. Graft introduction was performed via a 7-cm Pfannenstiel incision using an Alexis O Wound Protector-Retractor with Laparoscopic Cap (Applied Medical, Rancho Santa Margarita, CA, USA). Following robotic living donor nephrectomy, extracorporeal bench preparation was performed (warm ischemia time = 4 min; cold ischemia time = 239 min). RAKT was then completed with intracorporeal vasculares anastomoses using 5-0 Gore-Tex sutures (warm ischemia time = 45 min), and ureteral reimplantation according to the Lich-Gregoire technique, performed with 4/0 monofilament suture (3). The surgery was uneventful, with excellent graft reperfusion and no perioperative complications. Postoperative renal Doppler ultrasound and radionuclide renal scan were normal. Serum creatinine and eGFR at discharge were 1.45 mg/dL and 62 mL/min, respectively (4).
Conclusions:
Our experience confirms the feasibility and safety of RAKT with a living donor in a selected setting, supporting further integration of robotic assistance into renal transplantation programs.
Available at:VIDEO
ACKNOWLEDGMENTS
We thank the surgical, anesthesiology, and transplant coordination teams for their contributions. We thank our residents Dr. Giuseppe Aronica and Dario Brunello for helping with photo and video shooting. We thank Dr. Claudio Brancelli for helping with the video voice-over.
Footnotes
CONSENT: Informed consent was obtained from both donors and recipient for publication of this case report.
Data Availability
Uninformed
REFERENCES
- 1.Basile G, Pecoraro A, Gallioli A, Territo A, Berquin C, Robalino J, et al. Robotic kidney transplantation. Nat Rev Urol. 2024 Sep;21(9):521–533. doi: 10.1038/s41585-024-00865-z. [DOI] [PubMed] [Google Scholar]
- 2.Garisto J, Eltemamy M, Bertolo R, Miller E, Wee A, Kaouk J. Single port robot-assisted transperitoneal kidney transplant using the SP® surgical system in a pre-clinical model. Int Braz J Urol. 2020 Jul-Aug;46(4):680–681. doi: 10.1590/S1677-5538.IBJU.2019.191. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Pulford C, Keating K, Rohloff M, Peifer D, Eames R, Maatman T. How we do it: robotic-assisted distal ureterectomy with ureteral reimplantation. Int Braz J Urol. 2021 Nov-Dec;47(6):1277–1278. doi: 10.1590/S1677-5538.IBJU.2021.0207. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Leite RRA, Leite M, Jr, Einicker-Lamas M, Valverde RHF, Miranda LCD, Schanaider A. Clinical outcomes prediction in kidney transplantation by use of biomarkers from hypothermic machine perfusion. Int Braz J Urol. 2024 Jul-Aug;50(4):470–479. doi: 10.1590/S1677-5538.IBJU.2024.0166. [DOI] [PMC free article] [PubMed] [Google Scholar]
Associated Data
This section collects any data citations, data availability statements, or supplementary materials included in this article.
Data Availability Statement
Uninformed