V7-04: Completely Intracorporeal Robotic Renal Autotransplantation

Video

Introductions and Objectives
Totally intracorporeal robotic donor nephrectomy with autotransplantation has not been previously described. We present a video demonstration of this novel procedure.

Methods
A 56 year old man who suffered extensive ureteral loss after infectious complications of a perforated ureter presented for surgical management and was offered nephrectomy, ileal interposition, or renal autotransplantation with ureteroureterostomy. As a stone former, he chose the latter. This was performed with a total of 5 ports, including three 8mm robotic ports for robotic instruments. The donor nephrectomy was performed first robotically with cold perfusion of the renal artery intracorporeally with a catheter through the assistant port while the kidney was moved to the pelvis for vascular anastomosis to the external iliac vessels. A ureteroureterostomy was then performed over a stent.

Results
Console time was 5 hours and 43 minutes, and the entire procedure was performed intracorporeally with only 5 port incisions. Venous anastomosis time was 17 minutes during which the kidney was cold perfused, and arterial anastomosis time was 21 minutes. Blood loss was 25cc, and the patient was discharged on the first postoperative day with no complications. Doppler ultrasound showed excellent flow prior to discharge, and renal scan at 6 weeks confirmed excellent graft function. Ureteral patency was confirmed at 3 months by IVP.

Conclusions
We present the first report of a completely intracorporeal robotic donor nephrectomy and renal autotransplantation. This complex procedure should be offered selectively but with caution by highly experienced robotic renal surgeons.

Funding: None