Robotic assisted kidney transplantation: an initial experience.
OBJECTIVE
The use of robotics is a recent innovation in surgery. In addition to dexterity enhancement and motion scaling, this new technology opens the horizon of remote surgery. This latter advancement has potential use during surgery involving a high risk of patient-to-professional or professional-to-patient virus transmission. We investigated the feasibility of robotic assisted kidney transplantation.


METHODS
A right cadaveric kidney was transplanted into a 26-year-old male patient who has been on hemodialysis for 11 years. Surgery was done with the help of the da Vinci robot (Intuitive Surgical, Inc., Mountain View, California) by a remote surgeon, who completely performed vascular dissection and anastomosis as well as ureterovesical anastomosis. The role of the assistant by the side of the patient was limited to access creation, exposure, hemostasis and maintaining traction on the running sutures performed by the robot.


RESULTS
Operative time was 178 minutes. Robotic assistance made anastomosis possible by its unique ability of stereoscopic magnification and ultra-precise suturing techniques due to the flexibility of the robotic wristed instruments. Renal perfusion was excellent with immediate diuresis. Postoperative acute tubular necrosis started to resolve after 1 week.


CONCLUSIONS
This study demonstrates that robotic assisted kidney transplantation is feasible. Currently technical and cost hindrances limit the routine use of robots. However, with ongoing improvement and future availability of this technology the prevention of patient-to-professional and professional-to-patient viral transmission may become a potential field of application.
Hoznek
Andrá
A
Service d'Urologie and Service de Néphrologie, Centre Hospitalier Universitaire Henri Mondor, Créteil, France.
Zaki
Safwit K
SK
Samadi
David B
DB
Salomon
Laurent
L
Lobontiu
Adrian
A
Lang
Philippe
P
Abbou
Clément-Claude
CC
D000328:Adult; D004867:Equipment Design; D006801:Humans; D016030:Kidney Transplantation / Q000295:instrumentation* / Q000379:methods*; D008297:Male; D012371:Robotics