V9-03: Robotic Kidney Transplantation with Regional Hypothermia: a step-by-step Description of the VUI-Medanta Technique (IDEAL Phase 2a)

Video

Introductions and Objectives
We recently reported preclinical and feasibility studies (IDEAL phase 0-1) of the development of the novel surgical procedure, robotic kidney transplantation (RKT) with regional hypothermia. Here, we report the IDEAL phase-2a studies of technique development. Specifically, we describe our technique of RKT with regional hypothermia in a step-by-step manner along with the safety profile and early graft function in these patients.

Methods
This is a prospective study of 50 consecutive patients who underwent live donor RKT at Medanta Hospital, following a 3 year planning/simulation phase at the Vattikuti Urology Institute. Demographic details and outcomes are reported for the initial 25 recipients, who have completed a minimum 6 months follow up. The primary outcome was post transplant graft function. Secondary outcomes included technical success/failures and complication rates. The accompanying video details the operative technique.

Results
All fifty patients underwent RKT successfully; 7 in the phase-1 and 43 in the phase-2 stages of the study. For the initial 25 patients (Table 1); mean console, warm ischemia, arterial and venous anastomotic times were, 135 minutes, 2.4 minutes, 12 minutes and 13.4 minutes, respectively. All grafts were cooled to 18-20oC with no change in core temperature. All grafts functioned immediately post transplant and mean serum creatinine at discharge was 1.3 mg/dl (0.8-3.1 mg/dl). No patient developed anastomotic leaks, wound complications or wound infections. At 6 months follow up no patient had developed a lymphocele detected on CT scanning. Two patients underwent re-exploration, and 1 patient died 1.5 months post transplant of congestive heart failure.

Conclusions
RKT with regional hypothermia is safe and reproducible when performed by a skilled robotic surgical team.

Funding: NONE