Development of a Robotic Kidney Transplantation Program from Deceased Donors in a Referral Academic Centre: Technical Nuances and Preliminary Results.

OBJECTIVE: To report the development of the first robot-assisted kidney transplantation (RAKT) program from deceased donors examining technical feasibility and early perioperative and functional outcomes at a referral academic Centre.

PATIENTS AND METHODS: A robotic kidney transplantation program was developed in 2016 at our Institution following a structured modular training. 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 surgeon'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.

CONCLUSION: 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. This article is protected by copyright. All rights reserved.