Category: New Technology: Laparoscopy & Robotics

MP20-17 - Robot-assisted kidney transplantation in obese recipients: the Erus working group experience

Sat, Sep 22
2:00 PM - 4:00 PM

Introduction & Objective :

Kidney transplantation (KT) in obese patients (body mass index - BMI >30) presents several surgery challenges. According to the literature, in open KT, wound infection and lymphocele rate are 18% and 10%, respectively; delayed graft function (DGF) is reported up to 22% (1). In order to reduce the morbidity of the open KT, a robotic approach may be offered.


Methods :

An ERUS group was created in March 2016 with the aim to collect common prospective data on RAKT from living donor performed at 8 different European Centers. Functional outcomes, surgical data, intra- and post-operative complications in obese recipients with BMI > 30 were analyzed.


Results :

A total of 147 RAKTs from living donor were performed. 26 patients had BMI > 30. The mean age was 50 years (range: 24 - 65), mean BMI 33 kg/m2 (range: 30 - 40), mean pre-transplantation serum creatinine 638 mmol/L (range: 300 - 1150), mean GFR 9 ml/min per 1.73 m2 (range: 3-19). 13/26 were pre-emptive recipients. Mean overall surgical time was 226 min (range: 130 - 430) with mean vascular suture time of 40 min (range: 28 - 58), and estimated blood loss 100 ml (range: 50-250 ml). Mean overall ischemia time was 122 min (range: 65 – 377).  The average rewarming time was 54 min (range 35 – 84). One case required open conversion for hypoperfusion due to the graft position. On post-operative day (POD) 1, 3, 7, 30 the mean post-transplantation serum creatinine was 415, 275, 193, 149 mmol/L respectively. The mean GFR on POD 1, 3, 7, 30 was 17, 35, 44, 53 ml/min per 1.73 m2, respectively. One-year functional data were reported in 10 patients; at one-year follow-up, the mean creatinine and GFR were 127 mmol/L and 58 ml/min per 1.73 m2 respectively. DGF requiring dialysis in the first post-operative week occurred in 1 case. In terms of post-operative complications, we recorded 1 case of leakage from ureteral reimplantation, successfully managed with a nephrostomy tube and 1 case of bleeding requiring surgical exploration. Complications as surgical site infection, lymphocele, arterial stenosis and ureteral strictures didn’t occur. The mean hospital stay was 6 ± 1 days (range 4 - 8 days). The mean time of ureteral catheter was 31 days (range: 13 – 48) after the surgery.


Conclusions :

In an obese population, RAKT provides excellent graft function and low intra- and post-operative complication rate compared to the conventional open technique. It could therefore become the preferred technique in obese patients with end-stage renal disease. The benefits are related to the smaller skin incision and the easier vascular anastomosis and ureteral reimplantation.


 

Angelo Territo

licata, Sicilia, Italy

Giuseppe Basile

Reggio Calabria, Calabria, Italy

Antonio Alcaraz

Full Professor
Barcelona, Catalonia, Spain

MIreia Mosquera

Barcelona, Catalonia, Spain

Nicolas Doumerc

Paris, Lorraine, France

Karel Decaestecker

Ghent, Liege, Belgium

Desender Liesbeth

Ghent, Liege, Belgium

Paolo Fornara

Halle, Bayern, Germany

Nasreldin Mohammed

Halle, Bayern, Germany

Giampaolo Siena

Firenze, Toscana, Italy

Sergio Serni

Firenze, Toscana, Italy

Seculk Sahin

Instanbul, Artvin, Turkey

Volkan Tuğcu

chief
University of Health Sciences, Istanbul Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Department of Urology, Istanbul, Turkey
İstanbul, Istanbul, Turkey

VOLKAN TUGCU, M.D

Date of Birth: 05.04.1971

Phone Number: +90 532 551 07 29 E.mail: volkantugcu@yahoo.com

MEMORIAL HOSPITAL, BAHCELEVLER, ISTANBUL, TURKEY

EDUCATION

Faculty of Medicine, Uludag Univercity Medical Student 1991-1997

Bezm-i Alem Valide Sultan Vakif Gureba Urology Resident 1998-2003

Training and Research Hospital

Bakırköy Dr. Sadi Konuk Consultant of Urology 2003-2010 Training and Research Hospital

Bakırköy Dr. Sadi Konuk Training and Associate Prof. 2010-2016 Research Hospital

Bakırköy Dr. Sadi Konuk Training and Prof. of Urology 2016-2018 Research Hospital

T.C. Health Science University 2017-2018

Chief of Urology and Transplantation Deparments

Memorial Hospital 2018-

Chief of Urology and Transplantation Deparments

CLINICAL INTEREST

Transplantation, Urooncology, Minimally Invasive Surgery, Robotic Surgery, LESS

Michael Stockle

Berlin, Berlin, Germany

Alberto Breda

Barcelona, Catalonia, Spain