Category: Transplantation/ Donor Nephrectomy

Introduction & Objective :

Since the first successful kidney transplantation in humans performed in 1954, renal transplantation has become the standard of care for patients with renal failure. Recently, rapid evolution in robotic technology has broadened its application, pushing the frontiers of what is considered feasible in renal transplantation surgery.

Complex renal artery aneurysms involving multiple branches not amenable to endovascular treatment often require ex vivo repair with autotransplantation. We report a technique of extracorporeal vascular reconstruction followed by robotic assisted autotransplantation.

Methods :

A 22 year old lady was diagnosed with refractory hypertension. Renal angiogram showed a pinhole stenosis at the origin of the left renal artery, and more distally, a 10mm aneurysmal dilation which involved the branch point of the main renal artery. Repeated attempts at endovascular dilatation led to an infarcted upper pole and 37% remaining function. 

After a pure laparoscopic left donor nephrectomy, backtable dissection was performed to reconstruct the renal artery. Robotic assisted renal autotransplantation was performed using the da Vinc®i Si Surgical System. The main renal artery and vein was anastomosed to the external iliac vessels using 6.0 and 5.0 GORE-TEX®, respectively. An extraperitoneal pocket was created to stabilise the renal graft. An extraperitoneal tunnel was created for the ureter, and a ureteroneocystotomy was performed over a ureteric stent.

Results :

Warm ischaemic time was 37 min. Operative time for robotic renal autotransplantation was 121 min. Doppler US demonstrated good perfusion of the graft and low resistive index. Antihypertensives were ceased on day 2 and length of stay was 6 days. Post-operative CT angiogram showed a patent renal artery. There were no intra- or post-operative complications at 3 months.

Conclusions :

Extracorporeal vascular reconstruction followed by robotic renal autotransplantation is an option for patients whose anatomy is not amenable to endovascular options. We envision that this technique may change the landscape of transplantation surgery, broadening the application of robotic technology. Our case represents one of the initial reports of extracorporeal repair of a renal artery aneurysm with robotic autotransplantation. We believe that this technique is safe and feasible and may become the surgical approach of choice for renal transplantation in the near future.

Presenting Author(s)

• JY

  Jinna Yao

  – Urology Fellow, Discipline of Surgery, University of Sydney Medical School, Leichhardt, New South Wales, Australia

Author(s)

• AH

  Ahmer Hameed

  – Transplant Fellow, Department of Surgery, Westmead Hospital, Sydney, Australia, Sydney, New South Wales, Australia
• RA

  Richard Allen

  – Transplant and Vascular Surgeon, Department of Surgery, Westmead Hospital, Sydney, Australia, Sydney, New South Wales, Australia
• HP

  Henry Pleass

  – Transplant and Upper GI Surgeon, Department of Surgery, Westmead Hospital, Sydney, Australia, Sydney, New South Wales, Australia
• VL

  Vincent Lam

  – Transplant and Upper GI Surgeon, Department of Surgery, Westmead Hospital, Sydney, Australia, Sydney, New South Wales, Australia
• 

  Scott Leslie

  – Urological and Transplant Surgeon, Department of Urology, Royal Prince Alfred Hospital, Sydney, Australia, Sydney, New South Wales, Australia
• LK

  Lawrence Kim

  – Urological Surgeon, Department of Urology, Westmead Hospital, Sydney, Australia, Sydney, New South Wales, Australia
• HL

  Howard Lau

  – Urological and Transplant Surgeon, Department of Urology, Westmead Hospital, Sydney, Australia, Sydney, New South Wales, Australia