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Robot Assisted Transplant Allograft Nephrectomy Series: A Novel Approach for a Challenging Operation

Login to Access Video or Poster Abstract: MP06-03
Sources of Funding: None

Introduction

Despite improvements in medical care, surgical removal of failed transplant renal allografts may be mandated by sepsis, bleeding, pain, or erythropoietin resistance. Transplant nephrectomy has historically been performed in an open fashion by transplant surgeons and carries morbidity up to 50% with mortality up to 7%. To date, there is a single reported case of robot assisted transplant allograft nephrectomy from a deceased donor kidney. We herein present our series of robotic assisted transplant nephrectomy (RTN).

Methods

All patients who underwent robotic allograft nephrectomy at Mayo Clinic Arizona were included. Patients were not excluded for undergoing a concurrent procedure. All RTN were performed by a single Urologist (EPC) in conjunction with a single Transplant surgeon (NNK) via a transperitoneal approach utilizing a dual console Da Vinci Robotic Si/Xi surgical system. Study design was retrospective and observational. Variables analyzed included: demographics (age, BMI, ASA), comorbidities, transplant related (time from transplant to transplant nephrectomy, living related or deceased donor transplants), operative variables (operative time, estimated blood loss and additional procedures performed) peri-operative variables (length of stay (LOS), drain duration, Foley catheter duration, and hemoglobin change), and 30-day Clavien-Dindo complications. All variables were analyzed by non-parametric tests with commercially available software (SPSS vs, 21, Chicago, Illinois

Results

Six patients underwent RTN between 10/31/2014 until 4/31/2016. The time from transplant to transplant nephrectomy was a median of 5.9 years (range: 0.3 - 40). The majority of transplants were from deceased donors (66%). The median operating time was 306 minutes (range: 178 – 532). Of note, in two of the six RTN cases bilateral laparoscopic native nephrectomies were performed and in a third case a robotic nephrectomy and a lymph node biopsy by plastic surgery was performed. There were no intraoperative complications or conversions to open nephrectomy. Estimated median blood loss was 150 mL (range: 100 – 400), with a transfusion rate of 16%. Drains were utilized in 84% of patients and for a median of 2 days. There were three minor complications.

Conclusions

In this first reported series of robotic transabdominal allograft nephrectomy we demonstrate the safety and feasibility of the use of robotic technology for transplant nephrectomy. This is a small series that includes our learning curve.

Funding

None

Authors
Rafael Nunez
Nicholas Jakob
Sean McAdams
Kelli Gross
Haidar Abdul-Muhsin
Nitin Katariya
Erik Castle
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