To evaluate the outcomes and perioperative complication rates following robot- assisted transplant nephrectomy ((RATN).
All patients who underwent RATN at our institution were included. No exclusion criteria were applied. Clinical records were retrospectively reviewed and reported. This included preoperative, intraoperative, and postoperative outcomes. Complications were reported utilizing the Clavien-Dindo classification system. Descriptive statistics were reported using frequencies and percentages for categorical variables, means and standard deviation for continuous variables.
Between July 2014 and April 2018, 15 patients underwent RATN. Most patients had the transplant in the right iliac fossa (13/15). Ten patients underwent a concomitant procedure. The total operative time for the entire cohort was 336 (±102) minutes (including cases who had concomitant procedures) and 259 (±46 minutes) when cases with concomitant procedures were excluded. Mean estimated blood loss was 383 (±444) mL. Postoperatively, 3 patients required blood transfusion. Average hospital stay was 4 (±2.7) days. Most patients had finding consistent with graft rejection on final pathology. There were 5 complications; 3 of which were minor (grade 2 = 2 and grade 3 = 1); one patient had a wound infection requiring dressing (3A) and one patient died due to pulmonary embolism following discharge. Limitations include small series and retrospective nature of the study.
This case series demonstrate that RATN is technically feasible. With continued experience and larger case series, the robotic approach may provide a minimally invasive alternative to open allograft nephrectomy.
To read this article in full you will need to make a payment
Purchase one-time access:Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
One-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:Subscribe to Urology
Already a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
- OPTN/SRTR 2016 annual data report: kidney.Am J Transplant. 2018; : 18-113
- Allograft nephrectomy vs. no-allograft nephrectomy for renal transplantation: a meta-analysis.Clin Transplant. 2016; 30: 33-43
- Impact of allograft nephrectomy on second renal transplant outcome.Exp Clinic transplant. 2018; 16: 259-265
- Presence of a failed kidney transplant in patients who are on hemodialysis is associated with chronic inflammatory state and erythropoietin resistance.J Am Soc Nephrol. 2004; 15: 2494-2501
- Transplant nephrectomy improves survival following a failed renal allograft.J Am Soc Nephrol. 2010; 21: 374-380
- At the peril of dialysis patients: ignoring the failed transplant.Semin Dial. 2005; 18: 180-184
- Cumulative incidence, indications, morbidity and mortality of transplant nephrectomy and the most appropriate time for graft removal: only nonfunctioning transplants that cause intractable complications should be excised.J Urol. 2003; 169: 1242-1246
- Laparoscopic living-donor nephrectomy: analysis of the existing literature.Eur Urol. 2010; 58: 498-509
- Completely intracorporeal robotic renal autotransplantation.J Urol. 2014; 192: 1516-1522
- Robotic kidney transplantation with regional hypothermia: evolution of a novel procedure utilizing the IDEAL guidelines (IDEAL phase 0 and 1).Eur Urol. 2014; 65: 1001-1009
- Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation.Am J Transplant. 2013; 13: 721-728
- Robotic-assisted kidney transplantation.Surg Clin North Am. 2013; 93: 1309-1323
- Robot-assisted transplanted ureteral stricture management.Urology. 2017; 105: 197-201
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- Transplant nephrectomy: what are the surgical risks?.Ann Transplant. 2013; 18: 174-181
- Allograft nephrectomy.Br J Urol. 1976; 48: 413-417
- Robotic-assisted laparoscopic partial nephrectomy for a 7-cm mass in a renal allograft.Am J Transplant. 2011; 11: 2242-2246
- Robotic trans-abdominal transplant nephrectomy for a failed renal allograft.Am J Transplant. 2014; 14: 2883-2886
Published online: October 19, 2020
Accepted: October 6, 2020
Received: May 27, 2020
© 2020 Elsevier Inc. All rights reserved.