RENAL ALLOGRAFT WITH MULTIPLE VESSELS – THE ROBOTIC REBUTTAL

Description

Introduction: Robotic assisted kidney transplant (RAKT) is a feasible treatment option for patients with end stage renal disease. Despite the advantages of enhanced dexterity, wristed instruments, three-dimensional vision and scaled motion with robotic platform, the problem of increased warm ischemia times and longer vascular anastomosis time persists especially with multiple vessel renal allografts (MVRA).


Objective: To demonstrate technical feasibility of utilizing the internal iliac artery autograft (IIAA) in RAKT to reduce warm ischemia times in a triple vessel renal allograft.


Materials and methods: We present a novel demonstration of the technique to utilize the internal iliac autograft in RAKT to manage MVRA which has never been reported previously.


Surgical procedure: The technique is divided into three distinct steps. Step 1 is the retrieval of the IIAA, preparing the external iliac vessels for future anastomosis and raising a peritoneal flap for the transplant kidney. Step 2 involves bench dissection and ex-vivo vascular reconstruction to anastomose MVRA with IIAA. The final step is to anastomose this autograft-allograft complex with the external iliac vessels.


Results: We were able to perform a single in-vivo arterial anastomosis for a triple vessel renal allograft thereby reducing warm ischemia times.


Conclusion: Our technique eliminates the need for more than one arterial anastomosis, reduces the warm ischemia time and represents a novel method to manage grafts with multiple vessels during RAKT