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Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
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Robotic-Assisted Transabdominal Inferior Retroperitoneal Approach: an Alternative to Cattell-Braash Maneuver
S Jennifer Wang1, Jiping Wang2,3
1Department of Cancer Immunology and Virology, Dana-Farber Cancer Institute, Boston, MA, USA.
Summary
A new robotic-assisted transabdominal inferior retroperitoneal approach (TIRA) offers an alternative to the Cattell-Braasch maneuver for accessing the aorto-caval space (ACS). This minimally invasive technique shows promise for treating tumors in the inferior ACS with reduced patient recovery time.
Area of Science:
- Surgical Oncology
- Minimally Invasive Surgery
- Robotic Surgery
Background:
- The Cattell-Braasch maneuver has been the standard for aorto-caval space (ACS) exposure since the 1960s.
- This traditional approach involves complex visceral mobilization and significant physiological stress.
Purpose of the Study:
- To introduce and evaluate a novel surgical technique for accessing the ACS.
- The proposed method is the transabdominal inferior retroperitoneal approach (TIRA) with robotic assistance.
Main Methods:
- Patients were positioned in Trendelenburg.
- Retroperitoneal access was achieved from the iliac artery level.
- Dissection proceeded along the anterior surface of the inferior vena cava (IVC) and aorta toward the duodenum.
Main Results:
- TIRA was successfully applied to 5 patients with tumors in the inferior ACS (1.7–5.6 cm).
- Median operative time was 192 minutes with a median estimated blood loss (EBL) of 5 ml.
- Median length of hospital stay was 4 days, with 4 patients passing flatus by postoperative day 1.
Conclusions:
- Robotic-assisted TIRA is suitable for tumors in the inferior ACS, including those involving D3, D4, para-aortic, para-caval, and kidney regions.
- This approach avoids organ mobilization and utilizes avascular planes, making it adaptable to laparoscopic and open surgery.
