FIG. 2.

Intraoperative snapshots showing the step-by-step technique for vascular anastomoses during RAKT in our case. RAKT was performed by a dedicated robotic transplant team. Bench preparation of the graft included defatting, perfusion with Celsior^® solution, vessel preparation, and preplacement of a 6F, 14 cm DJ. The graft was then inserted into a gauze jacket filled with ice. (A) Skeletonization of external iliac vessels. The dissection was more extended in our case of RAKT to ensure avoidance of atherosclerotic plaques at the site of arterial anastomosis. (B) Insertion of the graft through the GelPOINT device without need of redocking. (C) Venous anastomosis. A venotomy (arrow) was performed using cold scissors. (D) The lumen of EIV was flushed with heparinized saline before anastomosis. (E, F) A running suture from the 12- to 6-o'clock position was performed to close the posterior plate using the needle driver on the surgeon's dominant hand and the Black diamond microforceps on the nondominant hand (E); then, a knot was tied and the anterior plate was completed with the same suture from the 6- to 12-o'clock position (F). (G, H) Linear arteriotomy and its conversion to circular arteriotomy using cold scissors. (I) Arterial anastomosis. Two half-running sutures starting at the 12 o'clock position and running toward the 6 o'clock position were performed with two threads to close the posterior and then anterior plates of the anastomosis. DJ, Double-J stent; EIA, external iliac artery; EIV, external iliac vein; GK, graft kidney; RA, renal artery; RAKT, robot-assisted kidney transplantation; RV, renal vein.