Robotic Assisted Dual Kidney Transplantation With Monolateral Iliac Vessels

To demonstrate the surgical technique of dual kidney transplantation in ipsilateral iliac fossa using da Vinci Si robotic platform METHODS: Dual kidneys from expanded criteria deceased donor were used in single recipients using robotic platform in 6 recipients. Following bench surgery, both kidneys were again placed into preservation fluid and ice-box. Robot was docked between 2 legs of the recipient. Common iliac and external iliac vessels on right side were dissected using robotic instruments. A 7 cm pfannenstiel incision was placed and one kidney was dropped into the abdomen; external aponeurosis was closed to restore the pneumoperitoneum. First kidney vascular anastomosis was done with common iliac vessels. Second kidney was introduced through the same wound and transplanted with external iliac vessels. Both ureters were implanted separately into the bladder.

Between January 2013 and December 2017, 6 patients had dual robotic-assisted laparoscopic kidney transplantation. All procedures were carried out successfully without conversion to open operation. Mean time for venous anastomosis, arterial anastomosis and total operation were 16.4 (10-19) minutes, 17.5 (13-24) minutes, and 359.1 (265-500) minutes. Mean blood loss was 188.3 (80-300) ml. Two patients had delayed graft function. One patient expired 3 months following transplant due to pneumonia.

Using 7 cm Pfannenstiel incision, dual robotic-assisted laparoscopic kidney transplantation with common iliac and external iliac vessels is technically feasible.