Urology Video Journal (Sep 2022)
Single port robot-assisted kidney transplantation: Extraperitoneal approach
Abstract
Objective: To describe in a video format the surgical steps and techniques of single-port robot-assisted extraperitoneal kidney transplantation using the SP da Vinci platform. Methods: We recorded the surgical steps and techniques of this procedure. After induction of anesthesia, and positioning the patient, a 5-cm peri or infra-umbilical incision is made and the extraperitoneal space is developed. GelPOINT access platform is placed and the robot is docked. The external iliac artery and vein are carefully dissected. The bench is performed using a LigaSure™ device to dissect the vessels. A ureteral stent is placed and the posterior surfaces of the artery and the vein are marked. The kidney is then wrapped with a blue surgical glove. After introducing some ice and the kidney into the extraperitoneal space, the robot is redocked, and venous and then arterial anastomoses are performed using 6–0 GORE-TEXⓇ sutures. After repositioning the kidney, ureteroneocystostomy is done. Nephropexy is then performed. The robot is undocked and the wound is closed. Results: Single-port robot-assisted kidney transplantation has been performed for 12 patients with end-stage renal disease. Allograft kidneys were from living and deceased donors in 9 and 3 patients respectively. Surgery was completed successfully in all patients without any complications. Median (IQR) vein and artery anastomosis times were 26 (24–28) and 37 (33–40) minutes, respectively. All grafts were perfused well on the color Doppler ultrasonography. Mean (SD) follow- up and creatinine were 11.25 (6.3) months, and 1.26 (1.16) mg/dL respectively. Conclusion: Extraperitoneal single-port robot-assisted kidney transplantation better duplicates open kidney transplantation and is associated with less number of overall incisions compared to the alternative robotic approaches.
