Presentation Authors: Mireia Musquera, Tarek Ajami*, Luis Peri, Maurizio D'anna, Laura Izquierdo, Antonio Alcaraz, Barcelona, Spain
Introduction: The use of robotics has permitted to perform difficult surgical techniques such as intracorporeal vascular anastomosis with good results in kidney transplantation.The aim of the study is to compare the results of the 50 first robotic assisted kidney transplantations (RAKT) with matched pair of open ones (OKT).
Methods: The data of the 50 RAKT was prospectively collected. A matched pair of OKT was selected from our database taking into account recipient and donor age, sex and BMI, preemptive transplant condition, and ABO compatibility. Surgical and post-operative results were assessed.
Results: Both groups had similar basal characteristics, regarding age, BMI, donor-recipient relationship, preemptive condition, ABO compatibility, and warm ischemia time. The number of multi-vessel grafts was similar in both groups (5 for RAKT, 6 for OKT). Operative time was higher in RAKT group (213min vs. 131 min p < 0.05). One transplantectomy was done in each group due to thrombosis; both cases were first kidney transplantation in a preemptive situation. Two RAKT cases were converted to open approach due to abnormal perfusion, the first one was spontaneously resolved and the other required graft revascularization caused by a problem with the bench end-to-side artery anastomosis. One OKT case needed reoperation due to hypoperfusion because of arterial kinking.The open approach had a higher transfusion rate (22% vs. 10% p=0.08) and postoperative haematuria (18% vs. 2% p=0.008) compared to RAKT. There was no difference regarding creatinine curve evolution. In the renal scintigraphy study, the RAKT group presented a lower tracer transit time (3 minutes vs. 4.6 minutes; p < 0.005); for this reason, this group had a lower tracer uptake (822 vs. 1070 p= 0.01). No difference was found in hospitalization days (8.7 vs. 9.5 days; p=0.2).OKT group had a higher eventration rate (6% vs 2%), seroma formation (4% vs. 0%) and ureterovesical anastomosis complications (urine leak, stenosis) (12% vs. 2%; p=0.05) compared to RAKT.With a median time of follow-up for 1.2 and 4.4 years, the graft survival is 98% and 96% for RAKT and OKT, respectively.
Conclusions: RAKT is an attractive approach for KT, being less invasive, having less complication rate and with the same functional results compared to the standard approach.