Robot-Assisted Radical Prostatectomy in Solid Organ Transplant Recipients: Initial Experience and Systematic Review

Area of Science:

• Urology
• Surgical Oncology
• Transplant Surgery

Background:

• Prostate cancer is a common malignancy in male solid organ transplant recipients (SOTRs).
• Radical prostatectomy in SOTRs presents technical challenges due to prior surgeries and graft proximity.
• Novel techniques are needed to improve safety and outcomes for SOTRs undergoing prostatectomy.

Purpose of the Study:

• To report the first use of indocyanine green (ICG) fluorescence for ureter identification and graft vascular mapping during robot-assisted radical prostatectomy (RARP) in SOTRs.
• To document the initial experience with the CMR Versius platform in a SOTR undergoing RARP.
• To evaluate the feasibility and safety of these combined techniques in a small cohort of SOTRs.

Main Methods:

• Retrospective case series of four male SOTRs (two renal, two hepatic) undergoing RARP.
• Utilized a dual-route ICG protocol for intraureteral and intravenous administration for ureter identification and graft perfusion mapping.
• One patient underwent RARP using the CMR Versius robotic system with a modified port placement.

Main Results:

• All four RARP procedures were completed robotically without conversion.
• Median operative time was 176 minutes with median estimated blood loss of 350 mL.
• Negative surgical margins (R0) were achieved in all patients; no graft dysfunction occurred. One patient experienced a Clavien-Dindo IIIa complication.

Conclusions:

• Indocyanine green-guided RARP and the CMR Versius platform are technically feasible in carefully selected SOTRs at experienced centers.
• No graft-related complications were observed in this initial series.
• Larger, multicenter studies are required to validate the safety and oncological efficacy of these approaches.