Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall C & D
*Purpose: Multiport robotic kidney transplantation has been described as a novel minimally invasive approach. We evaluate the feasibility of a robot-assisted single-port kidney transplantation using the Da Vinci SP® surgical system in a human cadaver.
*Methods: A left kidney graft was obtained from the local organ procurement organization after being declined by all transplant centers. The kidney was benched in a usual fashion and wrapped in cold sponges. A male cadaver was positioned in a steep Trendelenburg position. A single 4-cm midline incision was made in the midline 4- cm above the umbilicus. After getting access into the peritoneal cavity, an advances access platform (GelPOINT, Applied Medical, Rancho Margarita, CA, USA) was introduced percutaneously. The SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA) was docked aside the cadaver. Surgical steps for kidney transplantation were performed in the following order: 1) Dissection of external iliac vessels, 2) Robot was undocked and graft was inserted through the Alexis® wound retractor, 3) robot was re-docked and vascular anastomosis (renal vein end to side to external iliac vein and renal artery end to side to external iliac artery) were performed using ePTFE suture (Gore-Tex CV-6; W.L. Gore & Associates Inc, Flagstaff, AZ, USA. Bulldog clamps (Scanlan International, Arizona, St.Paul, MN) were used to recapitulate the surgical steps in living patients. 4) Ureterovesical implantion was performed over a transplant stent. Bed side assistance was provided through a dedicated port placed through the gel cap. The kidney was then harvested with the iliac vessels to examine the quality of the anastomosis. Operative times for all surgical steps were recorded.
*Results: The single-port robotic kidney transplantation was successfully completed in one human cadaver with no need for additional ports. Operative time was 182 minutes. Time needed to construct the venous, arterial and ureterovesical anastomosis was 35, 35 and 30 minutes, respectively. Anastomoses were patent when tested as will be shown in the surgical video.
*Conclusions: Robot single-port kidney transplantation is feasible using the SP® surgical platform. The SP robot eliminates the need for any additional incisions apart from that needed to place the kidney graft intracorporeally. Future clinical evaluation in humans is needed. Prospective comparison with other surgical platforms and standard techniques is warranted.
To cite this abstract in AMA style:Eltemamy M, Garisto J, Bertolo R, Miller E, Wee A, Kaouk J. Single-Port Robotic Kidney Transplantation: Initial Pre-Clinical Experience Using the SP Surgical System [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/single-port-robotic-kidney-transplantation-initial-pre-clinical-experience-using-the-sp-surgical-system/. Accessed November 19, 2019.
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