V8-02: Completely Intracorporeal Robotic Renal Autotransplantion
Completely intracorporeal robotic renal autotransplantation has been previously described, but this technique is still in its infancy. In this video, we demonstrate our technique of robotic renal autotransplantation performed in a completely intracorporeal fashion, replicating the open approach.
We constructed a method for performing renal autotrasplant via a robotic approach without the necessity of kidney extraction. Irrigation and cooling of the autograph was performed with the use of a laparoscopic specimen bag and intracorporeal instillation of ice slush. Renal hypothermia was assessed in real time with a thermocoupler needle probe. Intraoperative repositioning was required in order to perform the pelvic portion of the procedure. The patient in our report is a 31 year-old man with a history of a malrotated left kidney, recurrent renal stones and resultant hematuria-loin-pain syndrome.
Harvesting of the left-sided renal unit was performed with the patient in left-side up modified flank position with robotic ports in similar arrangement to robotic partial nephrectomy. Once harvested, autotransplantation was performed in dorsal lithotomy position. Warm ischemia time prior to renal cooling was 6 minutes. Intracorporeal cold ischemia was achieved with intra-arterial irrigation of Wisconsin fluid and ice slush hypothermia performed with the use of a laparoscopic specimen bag without extracting the organ from the body. Cold ischemia was 148 minutes. Total operating room time was 433 minutes and estimated blood loss was 100 cc. The patient underwent renal Doppler ultrasound immediately after surgery and on the first post-operative day with good results and demonstrable renal viability. He was discharged home on the third post-operative day.
We describe a safe and feasible method for performing robotic renal autotransplantation without need for renal extraction. This procedure should be reserved for experienced robotic surgeons at centers where autotransplantation is performed routinely, as transplant expertise is required. Open renal autotransplantation remains the gold standard. As with any new procedure, this technique will continue to be refined. Larger series with long-term outcomes are needed.