[ROBOTIC-ASSISTED KIDNEY TRANSPLANTATION - IMPLEMENTATION AND INITIAL EXPERIENCE AT BEILINSON TRANSPLANT CENTER]

Robotic-assisted kidney transplantation (RAKT) has brought the benefits of minimally invasive surgery to the field of renal transplantation. The robotic platform overcomes some of the major limitations of the laparoscopic approach facilitating complex surgical procedures such as kidney transplantation with non-inferior or improved outcomes, particularly in obese patients. In this article we describe the implementation of the RAKT program, donor and recipient selection, our unique surgical technique, and analyze early results.

This is a retrospective study of all RAKTs performed at our center between September 2020 and August 2021. For our initial experience and learning curve we selected non-obese end-stage renal disease patients, with no significant iliac vessels atherosclerosis, and living donor left kidney grafts with single artery.

During the study period 9 patients underwent living donor RAKTs. One case required conversion to open surgery. The mean age of recipients was 41.5 years (29-65 years) and 8 were males (89%). Mean body mass index (BMI) was 26.1 Kg/m2 (24 - 28.9 Kg/m2). Mean operative time was 265 minutes (220-310) and mean warm ischemia time (WIT) was 51 minutes (45-70). No major intraoperative complications occurred and there was no graft loss. All patients had immediate graft function with only one case of delayed graft function (DGF) due to hyperkalemia. One patient was treated empirically for suspected acute rejection with good response. Mean length of hospital stay was 8.25 days (7-10) and all patients were discharged with good renal function. At a mean follow-up time of 8.3 months (3-13 months) all patients have good graft function and RAKT graft survival is 100%.

The robotic approach is a minimally invasive method for kidney transplantation, yielding good results, comparable to the traditional open approach. With further experience, RAKT may be an attractive option for patients, particularly obese, necessitating renal transplant.