373 Orthotopic robot-assisted kidney transplantation Dr Alessio Pecoraro

This video is being presented at the Humans at the Cutting Edge of Robotic Surgery Symposium 2024, Jaipur, India. It was produced by Dr Alessio Pecoraro, Fundació Puigvert, Barcelona, Spain.
Abstract:
Orthotopic robot-assisted kidney transplantation: surgical technique and preliminary results
Alessio Pecoraro1,2, Begoña Etcheverry3, Josep Maria Gaya1, Angelo Territo1, Andrea Gallioli1, Camille Berquin1,4
,
Giuseppe Basile1,5, Pietro Diana1
, Thomas Prudhomme6, Nicolas Doumerc6, Francesc Vigués3 and Alberto Breda1
1Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; 2Unit of Urological
Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence,
Italy; 3Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain;
4Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre; 5Department of
Urology and Division of Experimental Oncology, URI, Urological Research Institute, IRCCS San Raffaele Scientific
Institute, Milan, Italy; 6Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse,
France.
1. Introduction
Kidney transplant (KT) candidates are fragile and immunocompromised patients and they are more often older, with
several comorbidities. However, some of them present a retained iliac fossa from a previous KT or for severe
atherosclerotic calcification. In this challenging setting, KT recipients and particularly those patients who are
candidates for an orthotopic KT, could benefit the most from the implementation of minimally invasive approach,
potentially improving the recipient vessels dissection and the vascular anastomoses, as well as perioperative
outcomes. In this video, we report the largest experience about orthotopic robot-assisted KT (ORAKT), focusing on
technical nuances and perioperative outcomes.
2. Materials and methods
After ethical committee approval, we retrospectively collected data regarding patients who underwent ORAKT
between January 2020 and August 2023 at three European referral transplant centers.
All ORAKTs were performed by a highly experienced robotic and transplant surgeon. The primary aim was to assess
the technical feasibility and safety.
3. Results
Overall, 16 ORAKTs were included. Of these, 4 (25%) were from donors after cardiocirculatory death, 5 (31%) from
donors after brain death and 7 (44%) from living donors.
Notably, all KT were carried out in the left renal fossa. Severe calcification of the external iliac vessels (100%), often
with a previous iliac fossa KT (31%), drove ORAKT. The median recipient age was 66 (IQR 63–71) years and the median
BMI was 26 (23–29) kg/m2
.
Surgical open conversion occurred in 12.5% of cases with a median operative time of 295 (268-360) minutes. An end-
to-end anastomosis between graft artery and native left renal artery was performed in 75%, while 25% had an end-to-
end anastomosis with the splenic artery. Graft vein anastomosed with the native renal vein in all cases. A uretro-
ureteral anastomosis was reported in 81% of cases, while pyelo-ureteral anastomosis and ureteral reimplantation
were carried out in 2 and 1 case, respectively. During the first 30-days after ORAKT, any grade postoperative
complications were recorded in 11 (69%). Of these, 3 patients experienced high-grade complications (Clavien-Dindo
greater than 2).
4. Conclusion
This study presents the largest ORAKT series reported, suggesting the robotic approach offers a safe minimally
invasive alternative for select patients unsuitable for heterotopic KT in high-volume KT centers with robotic expertise
and prior heterotopic RAKT experience. Robotic surgery can reduce perioperative complications, postoperative pain,
and hospital stays while enabling precise dissection of the native renal vein and splenic artery and accurate vascular
anastomoses.

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