Introduction

Kidney transplantation (KT) is the preferred treatment for patients with end-stage renal disease. In order to reduce the morbidity of the open surgery, a robotic assisted approach has been recently introduced. According to the literature, the robotic surgery allows the performance of KT under optimal operative conditions while maintaining the safety and the functional results of the open approach. We present the one-year results from the ERUS Robotic Kidney Transplantation Group common prospective recruitment database of Robotic assisted kidney transplantats (RAKT) on 69 cases.

Methods

An ERUS RAKT group was created in July 2015 with the intent of generating prospective data on robotic kidney transplantation. A common prospective recruitment database of RAKT performed at 8 different European Centers was therefore created in July 2015. Functional and surgical data were analyzed and herein reported.

Results

The patients demographic characteristics were as follows: 29 adult females and 40 males with mean age 42 years old (range: 25-64), mean BMI 26 kg/m2 (range: 22-33), and mean pre-transplantation serum creatinine 484 umol/L (range: 98-919) with a mean GFR: 10.4 ml/min per 1.73 m2 (range: 3-29). There were no vascular and ureteral anomalies in the cases included. The mean ASA score were 2. Overall surgical time was 324 min (range: 220-430) with vascular suture time of 42 min (range: 32-48), and estimated blood loss < 80 ml. Overall ischemia time (including warm ischemia, cold ischemia and rewarming time) was 98.9 min (range: 84-140). The average rewarming time was 55 min (range 51-58). Two patients were converted to open transplantation. No major surgical intra- operative complications were observed. There were two cases (3%) of transplantectomy for a massive arterial thrombosis on POD 2. One case of intraperitoneal hematoma occurred on POD 1, and was successfully managed laparoscopically. The mean post-operative serum creatinine level was 204 umol/L (range: 81-479) on post-operative day (POD) 7. Post-operative pain, evaluated with Visual Analog Scale (VAS) score, was optimal. The mean hospital stay was 6 ± 1 days (range 4-8 days). The mean time of ureteral catheter was 15 days (range: 14-16) after the surgery. There were five cases (7%) of delayed graft function although at 1 month follow up. Furthermore, no arterial nor ureteral strictures occurred.

Conclusions

This is the first European study on RAKT. RAKT with regional hypothermia appears to be a safe and reproducible surgical procedure in a properly selected group of patient. The potential advantages of RAKT are related to the quality of the vascular anastomosis, the possible lower complication rate and the shorter recovery of the recipients. The success rate in this group is comparable to conventional open KT.

Funding

none