Current Status of Robotics in Renal Transplantation
Dr Anup Kumar
Prof & HOD, Department of Urology and Renal Transplant ,
VMMC and Safdarjang Hospital,
New Delhi ,India
Traditional renal transplant is carried out via a large16-20 cm Gibson’s incision which results in significant pain, delayed convalescence and poor cosmesis. Rosales et al in 2010 reported the 1st case of laparoscopic renal transplant, which was followed by multiple series that demonstrated similar efficacy but faster convalescence and better cosmesis. With the advent of robotic platform and its associated advantages, description of robotic renal transplant was inevitable. The first report of robotic kidney transplant came from France where kidney was placed by an open incision and the anastomosis was made robotically. As the experience with the technique increased, totally robotic transplant was performed, both in trans-peritoneal space and in retro-peritoneal space. Placing the graft into the abdominal cavity made a subsequent biopsy difficult and also risked torsion. Thus, retro-operationalization of a trans-peritoneal graft, by raising the peritoneal flap and placing the graft behind it became the commoner technique.
Also, it was hypothesized that increased warm ischemia time (WIT) may lead to delayed graft function which was noted in the minimal invasive approaches and thus the technique of regional hypothermia as described in Vattikutti-Medanta technique avoids prolong WIT. Another, benefit of robotic kidney transplant has been noted in obese patients, where high BMI may preclude open surgery and robotic surgery has been shown with acceptable outcomes. To conclude, robotic kidney transplant provides equivalent graft and patient outcomes with lower post operative pain, faster recovery and better cosmesis.This technique can decrease the morbidity of renal transplant recipients substantially with very good functional renal graft outcomes .