Presentation Authors: Riccardo Campi*, Graziano Vignolini, Francesco Sessa, Isabella Greco, Firenze, Italy, Aida Larti, Florence, Italy, Saverio Giancane, Arcangelo Sebastianelli, Mauro Gacci, Adriano Peris, Firenze, Italy, Alberto Breda, Barcellona, Spain, Giampaolo Siena, Vincenzo Li Marzi, Florence, Italy, Sergio Serni, Firenze, Italy
Introduction: To date, the vast majority of the global experience on RAKT was achieved in the setting of living donation and formal reporting of perioperative and functional results of RAKT using grafts from deceased donors is a key unmet need. The aim of the study is to report the development of a robot-assisted kidney transplantation (RAKT) program from living and deceased donors focusing on technical feasibility and early perioperative and functional outcomes at a referral academic Centre.
Methods: A robotic kidney transplantation program was developed in 2016 at our Institution following a structured modular training, taking advantage of an extensive experience in open kidney transplantation (>1000 transplantations from 1991) and robotic urologic surgery (>3500 procedures from 2010), as well as a codified surgical technique for RAKT. Specific inclusion/exclusion criteria for both living and deceased donors were set. Data from patients undergoing RAKT from January 2017 to April 2018 were prospectively collected in an a priori developed web-based dataset. RAKT followed the principles of the Vattikuti-Medanta technique with specific technical modifications based on clinical recipient characteristics as well as surgeonâ€™s skills and preference during the learning curve. Technical feasibility of RAKT from deceased donors and evaluation of perioperative and early functional outcomes were the main study endpoints.
Results: Seventeen RAKTs were performed during the study period. Of these, six were from living-donors while 11 from deceased donors. All RAKTs were successfully completed without need of conversion. Median console times was 190 min (IQR 160-220), while median estimated blood loss 120 cc (IQR 110-140). Median times to complete venous, arterial and uretero-vesical anastomoses were 21, 22 and 21 min, respectively. Median length of hospitalization was 8 days (IQR 6-12). At a median follow-up of 8 months (IQR 6-11), five (30%) complications were recorded. Of these, four (24%) were minor (Clavien-Dindo grade I-II) while one major (Clavien-Dindo grade IIIb requiring graft nephrectomy). Overall, two patients were still on dialysis at last follow-up. A significant improvement in graft function was recorded progressively at all postoperative time points.
Conclusions: Our preliminary experience outlines that: a) the development of a RAKT program is feasible in Centres experienced robotic surgery and open KT; b) RAKT from deceased donors is feasible from both a technical and logistical perspective and c) RAKT from deceased donors appears to achieve favourable early postoperative and functional outcomes. Larger studies with longer follow-up are needed to confirm these findings and compare the outcomes of RAKT from deceased donors with those from living donors.