New Technology: Laparoscopy & Robotics

Moderated Poster Session

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

Saturday, September 22
2:00 PM - 4:00 PM
Location: Room 242B

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

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    Giuseppe Basile

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      Antonio Alcaraz

      Full Professor

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        MIreia Mosquera

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          Nicolas Doumerc

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            Karel Decaestecker

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              Desender Liesbeth

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                Paolo Fornara

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                  Nasreldin Mohammed

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                    Giampaolo Siena

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                      Sergio Serni

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                        Seculk Sahin

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                          Volkan Tuğcu

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

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                            Michael Stockle

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                              Alberto Breda

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