Background: Morbidly obese patients with end stage renal disease have a lower chance of obtaining kidney transplantation than non-obese counterparts because of high risk of surgical site infection and poor outcome for graft and patient survival. Robot assisted single procedure with modified techniques for renal transplantation and weight reduction may benefit this increasingly large subset of population.

Methods: This is our first patient in an IRB approved proposed series of prospective randomized trial designed to compare simultaneous robotic bariatric surgery and robotic living donor kidney transplantation to robotic transplantation alone in obese patients with end stage renal disease. Primary objective is to assess the safety and efficacy of performing both procedures simultaneously.

Case: 35 year old Hispanic women with a BMI of 42 on dialysis for IgA nephropathy was worked up as per the institutional and NIH guidelines for bariatric surgery as well as kidney transplantation.

Surgical technique: Patient in low lithotomy with trocars placed strategically. With the da Vinci robot docked cranially, the greater curvature of stomach was freed from vascular connections. Using a 40 Fr. Bougie to size the sleeve, the stomach was stapled and transected sequentially. A hand port was placed. The da Vinci robot was docked from patient right lateral pelvis, the right iliac artery and vein were dissected free and clamped. The donor kidney inserted through the hand port and the renal vein, artery and ureter were anastomosed appropriately.

Results: EBL was 200 ml, OR time of 583 minutes, patient discharged on POD 4. See Table 1.

Conclusion: This first case in a randomized prospective trial indicates that weight reduction surgery and living kidney transplantation can be performed safely. The trial will elucidate whether combining transplantation and bariatric surgery is superior to transplantation alone in an obese kidney failure population.

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