Robotic Assisted Live Donor Kidney Transplantation - Technique and Outcomes
Pahari H, Waldman B, Stracke J, Malinzak L, Denny J, Kim D, Jeong W, Menon M, and Yoshida A. Robotic Assisted Live Donor Kidney Transplantation - Technique and Outcomes. Am J Transplant 2018; 18:379.
Am J Transplant
Background: Robotic assisted kidney transplantation (RAKT) is now a feasible minimally invasive option in place of open living donor kidney transplant (OKT). Here, we briefly describe and compare the technical aspects and outcomes. Methods: From Jan 2013 to Aug 2017, we compared a total of 94 OKTs and 27 RAKTs and analyzed their outcomes. Results: The technique of RAKT included Trendelenburg in a modified lithotomy position at 10 degrees, placement of a midline Gellpoint port, 2 other robotic and 1 assistant ports. This was followed by intraperitoneal kidney implantation. Of the 27 recipients, 2 patients were converted to open because of technical complications. RAKT offered lower blood loss and lower cold ischemia time, while warm ischemia time was higher. There was no increased incidence of delayed graft function, with similar post-operative pain and length of stay. There was lower incidence of wound related complications in RAKT. Patient and graft survival was 100% for both. We divided our first 13 and our next 14 RAKTs for comparison. With experience, our mean blood loss and cold ischemia times have decreased moderately, while warm ischemia times decreased significantly (p=0.029). The mean pain scores and days to ambulation were also much lower in the latter period. Conclusions: RAKT offers minimally invasive option with equivalent outcomes to open kidney transplants. In obese patients, it is technically easier to perform. It has a short learning curve with a trend towards lower pain and warm ischemia times. RAKT can provide a minimally invasive option with equal or better short term patient outcomes while maintaining excellent renal outcomes.