Presentation Authors: Benjamin Van Parys*, Jeroen Van Besien, Ghent, Belgium, Nicolas Doumerc, Toulouse, France, Liesbeth Desender, Caren Randon, Frederic De Ryck, Thomas Tailly, Matthias Beysens, Carl Van Haute, Ghent, Belgium, Diederik Ponette, Ostend, Belgium, Kathia De Man, Piet Hoebeke, Frank Vermassen, Karel Decaestecker, Ghent, Belgium
Introduction: Kidney autotransplantation (KAT) is the ultimate way to salvage kidneys with complex renovascular, ureteral or malignant pathologies that are not amendable to in situ reconstruction. Minimal invasive approach could broaden its adoption, due to the lower morbidity and high quality of anastomosis. We give an update of perioperative parameters and early (3 months) functional outcomes of the first robot-assisted kidney autotransplantation (RAKAT) series.
Methods: 10 patients underwent RAKAT (male/female 3/7; left/right 8/2), for complex ureteral strictures (8), severe left renal vein nutcracker (1) and loin-pain hematuria syndrome (1), between March 2017 and September 2018. Alternatives discussed with the patients were laparoscopic nephrectomy, Boari flap and ileal interposition. All patients gave written informed consent. In 9 patients the kidney was exteriorised for preparation on the bench; 2 patients underwent table top vascular reconstruction and 1 ex vivo flexible ureteroscopy to extract a 6 mm lower pole lithiasis. The technique is presented in the enclosed figure.
Results: RAKAT was successful in all patients. Mean operative and console time was 405 and 304 min with median vascular and ureteral anastomosis time 25 and 23 min. Median warm, cold and rewarming ischemia time was 3, 175 and 48 min respectively. No patient needed open conversion. 3 patients had a major 90d postoperative complication (grade 3b): wound dehiscence needing wound revision, stent dislodgment needing repositioning and left calf compartment syndrome needing fasciotomy without lasting disability. Median hospital stay was 6 days. At 3 months, all patients were free of indwelling stents, pain or hematuria and showed good vascularisation and absence of hydronephrosis of the autograft on ultrasound. Nuclear DMSA and Cr-EDTA scans 3 months postop showed no transplant kidney function loss in 5, a significant GFR drop in 2 and a significant GFR increase in 3 autotransplants.
Conclusions: We describe the first series of a minimal invasive technique for KAT. RAKAT is a promising approach to salvage kidneys in selected patients with complex and disabling ureteral or renal pathology. RAKAT resolves the disabling symptoms and results in good function of the autotransplant at 3 months.