Robotic Kidney Transplantation—an Update
- 233 Downloads
Purpose of Review
Over the last decade, there have been advances in kidney transplantation with introduction of minimally invasive surgery. Robotic surgery is becoming increasingly common across the specialities. There is now increasing experience in robotic kidney transplantation, though it remains a niche procedure. Initial reports suggest that this is a safe, feasible operation when performed by teams familiar with robotic surgery. There have been a few modifications to the initially described procedure, as a result of increasing experience.
There is no significant difference in graft and patient survival when compared with open surgery and laparoscopic kidney transplantation. It is a safe procedure and therefore represents a viable alternative to open surgery in selected patients particularly the obese. The advantages include less postoperative pain and fewer wound complications such as surgical site infections and hernia, which could be particularly advantageous in the obese.
Robotic kidney transplantation is procedure that has been developed over the last decade and could have applicability in kidney transplantation in the obese. Its main benefit is in enabling surgery in less accessible spaces due to body habitus, combined with those of using a smaller incision with less associated morbidity, with no inferiority in the reported primary outcomes of graft and patient survival. There are capital costs associated with this procedure, but further studies on the cost-effectiveness of robotic kidney transplantation are needed before it can be adopted widely.
KeywordsKidney transplantation Robotic surgery Robotic kidney transplant Obesity surgery
Body mass index
Laparoscopic kidney transplant
Minimally invasive surgery
Open kidney transplant
Robotic kidney transplant
Surgical site infection
The authors would like to thank Professor Pranjal Modi of the Institute of Kidney Diseases and Research Centre in Ahmedabad, India, and Mr. P Sooriakumaran, consultant urologist at the Oxford University Hospitals NHS Trust for their insight and advice during the planning and preparation of this review.
Compliance with Ethical Standards
Conflict of Interest
Visesh Sankaran and Sanjay Sinha each declare no potential conflicts of interest.
Human and Animal Rights and Informed Consent
This article does not contain any studies with human or animal subjects performed by any of the authors.
Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance
- 2.Levi Sandri GB, de Werra E, Masciana G, Guerra F, Spoletini G, Lai Q. The use of robotic surgery in abdominal organ transplantation: a literature review. Clinical transplantation. 2017;31(1). doi: 10.1111/ctr.12856.
- 4.Renoult E, Hubert J, Ladriere M, Billaut N, Mourey E, Feuillu B, et al. Robot-assisted laparoscopic and open live-donor nephrectomy: a comparison of donor morbidity and early renal allograft outcomes. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association. 2006;21(2):472–7. doi: 10.1093/ndt/gfi150.CrossRefGoogle Scholar
- 5.Gorodner V, Horgan S, Galvani C, Manzelli A, Oberholzer J, Sankary H, et al. Routine left robotic-assisted laparoscopic donor nephrectomy is safe and effective regardless of the presence of vascular anomalies. Transplant international : official journal of the European Society for Organ Transplantation. 2006;19(8):636–40. doi: 10.1111/j.1432-2277.2006.00315.x.CrossRefGoogle Scholar
- 6.Pietrabissa A, Abelli M, Spinillo A, Alessiani M, Zonta S, Ticozzelli E, et al. Robotic-assisted laparoscopic donor nephrectomy with transvaginal extraction of the kidney. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2010;10(12):2708–11. doi: 10.1111/j.1600-6143.2010.03305.x.CrossRefGoogle Scholar
- 11.• Menon M, Sood A, Bhandari M, Kher V, Ghosh P, Abaza R, et al. Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a). Eur Urol. 2014;65(5):991–1000. doi: 10.1016/j.eururo.2013.12.006. A paper outlining the evolution of the technique and describing the procedure in detail CrossRefPubMedGoogle Scholar
- 12.• Oberholzer J, Giulianotti P, Danielson KK, Spaggiari M, Bejarano-Pineda L, Bianco F, et al. Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation. Am J Transplant Off J Am Soc Transplant Am Soc Transplant Surg. 2013;13(3):721–8. doi: 10.1111/ajt.12078. Results of 28 obese patients in a prospective study of robotic kidney transplantation versus open surgery. At six months, they showed no significant difference in graft function or loss and a significant reduction in SSI CrossRefGoogle Scholar
- 14.•• Wagenaar S, Nederhoed JH, Hoksbergen AW, Bonjer HJ, Wisselink W, van Ramshorst GH. Minimally invasive, laparoscopic, and robotic-assisted techniques versus open techniques for kidney transplant recipients: a systematic review. Eur Urol. 2017; doi: 10.1016/j.eururo.2017.02.020. A thorough systematic review of published articles comparing the outcomes from open, laparoscopic and robotic kidney transplanation. Though comprising of relatively small series, this systematic review suggests that robotic surgery is safe and effective and is not inferior when compared with open surgery in terms of graft loss and function PubMedGoogle Scholar
- 16.KAG. Patient selection for deceased donor kidney only transplantation. Policy. www.odt.nhs.uk: NHSBT2016 25/02/2016 Contract No.: POL1184/2.2
- 18.•• Garcia-Roca R, Garcia-Aroz S, Tzvetanov I, Jeon H, Oberholzer J, Benedetti E. Single center experience with robotic kidney transplantation for recipients with BMI of 40 kg/m2 or greater: a comparison with the UNOS Registry. Transplantation. 2016; doi: 10.1097/tp.0000000000001249. This paper outlines the experience of a centre with the largest recorded series of robotic kidney transplants in the obese population and compares outcomes with national UNOS data. Their data show that robotic transplantation is a viable option for those patients too obese to be considered for open surgery, and that their outcomes in terms of graft function and loss and mortality are comparable, with significantly reduced rate of SSI PubMedGoogle Scholar
- 19.• Doumerc N, Roumiguie M, Beauval JB, Soulie M, Rischmann P, Kamar N, et al. Robotic kidney transplantation for morbidly obese patients excluded from traditional transplantation. Obes Surg. 2017;27(4):1056–7. doi: 10.1007/s11695-016-2489-1. This letter relates to a series of two obese patients who underwent robotic kidney transplantation with success. This is the first such reported set of cases in Europe CrossRefPubMedGoogle Scholar
- 22.Tzvetanov I, D'Amico G, Georgiev G, Jeon H, Garcia-Roca R, Benedetti E et al. 2015. Combined robotic kidney transplantation and sleeve gastrectomy in obese recipients: initial results from prospective randomized study [abstract]. American Transplant Congress; Philadelphia. American Journal of Transplant http://www.atcmeetingabstracts.com/abstract/combined-robotic-kidney-transplantation-and-sleeve-gastrectomy-in-obese-recipients-initial-results-from-prospective-randomized-study/