Robotic Assisted Kidney Transplantation- Challenges

This video was a Finalist for the 2019 KS National Robotic Surgery Video Awards, screened and adjudicated at the Robotic Surgeons Council of India meeting.  Presented by Dr. Himanshu Sharma.  

Robotic assisted kidney transplantation (RAKT) has recently been introduced as a management option for patients with end stage renal disease. While open kidney transplant (OKT) remains the gold standard, RAKT is increasingly being adopted across the world as a technique with equivalent outcomes and lesser complications especially for the obese patient. The challenges encountered during the performance of vascular anastomosis owing to multiple renal vessels and right-sided renal allograft transplant (short renal vein) are potential reasons for non-selection of patients for RAKT as well as open conversion.

The techniques used for managing multiple vessel renal allograft were side to side trousering of multiple vessel renal allograft on the bench (5 in RAKT versus 1 in OKT) followed by robotic assisted vascular anastomosis, end to side anastomosis of single renal artery to external iliac artery (8 in RAKT versus 10 in OKT), anastomosis of smaller caliber, accessory renal allograft artery to the inferior epigastric artery (2 in RAKT versus 1 in OKT) and double barreled anastomosis of double vessel renal allograft to two separate arteriotomy incisions made in the external iliac artery (3 in RAKT versus 6 in OKT)

RAKT is a feasible option for patients receiving right-sided as well as multiple vessel renal allografts and the challenges could be safely overcome by the techniques described.