Korean J Transplant.  2023 Nov;37(Suppl 1):S245. 10.4285/ATW2023.F-8383.

Advancing kidney transplants: future prospects of robotic graft implantation

• Abreu P
• Manzi J
• Morsi M
• Figueiro J
• Burke G
• Ciancio G
• Guerra G
• Vianna R

• KMID: 2551874
• DOI: http://doi.org/10.4285/ATW2023.F-8383

Abstract

Background
Kidney transplantation significantly enhances survival for end-stage renal disease patients. Robotic surgery has evolved, yet complex procedures require technical standardization. Graft implantation demands expertise and reduced warm ischemia time for optimal function. We present a series of 27 cases featuring robotic-assisted kidney allograft implantation.
Methods
Prospectively gathered data of patients who underwent robotic-assisted left donor nephrectomies at Jackson Memorial Hospital, University of Miami, Miami Transplant Institute, from April 2022 to July 2023 during the Transplant Robotic Programs second phase. Preoperative, intraoperative, and postoperative variables were analyzed. Continuous variables underwent Student t-test analysis, categorical variables were chi-square tested, and P<0.05 indicated significance.
Results
Included were 27 patients; 20 (74%) were male, median age 50 years (interquartile range [IQR], 32.5 58.5 years). Living donor grafts comprised 25 (92.5%). Pfannenstiel incision was used in 22 (81.4%) cases for graft insertion. Median warm ischemia time was 51 minutes (IQR, 39.25–57 minutes). Median vein anastomosis time was 16 minutes (IQR, 12–19 minutes); artery anastomosis time was 14 minutes (IQR, 11–18 minutes). Median intraoperative robotic console time was 212 minutes (IQR, 178–364 minutes). Foley catheter removal took 7 days (IQR, 6–7 days). Median stay was 3 days (IQR, 3–4.5 days). Graft function was immediate in 25 cases (92.6%), delayed in 2 (7.4%). There were one postoperative readmission (3.7%), six complications (22%), and two reinterventions (7.4%) due to urinary leaks. Conversion to open surgery occurred in one patient (3.7%).
Conclusions
Robotic-assisted kidney allograft implantation is a safe procedure with minor complications, recommending its application where robotic surgery is accessible.