title: Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a).
abstract: BACKGROUND
  We recently reported on preclinical and feasibility studies (Innovation, Development, Exploration, Assessment, Long-term study [IDEAL] phase 0-1) of the development of robotic kidney transplantation (RKT) with regional hypothermia. This paper presents the IDEAL phase 2a studies of technique development.
  
  
  OBJECTIVE
  To describe the technique of RKT with regional hypothermia developed at two tertiary care institutions (Vattikuti Urology Institute and Medanta Hospital). We report on the safety profile and early graft function in these patients.
  
  
  METHODS
  This is a prospective study of 50 consecutive patients who underwent live-donor RKT at Medanta Hospital following a 3-yr planning/simulation phase at the Vattikuti Urology Institute. Demographic details, and perioperative and postoperative outcomes are reported for the initial 25 recipients who have completed a minimum 6-mo follow-up.
  
  
  METHODS
  Positioning and port placement were similar to that used for robotic radical prostatectomy. Allograft cooling was achieved by ice slush delivered through a GelPOINT device. The accompanying video details the operative technique.
  
  
  METHODS
  The primary outcome was posttransplant graft function. Secondary outcomes included technical success or failure and complication rates.
  
  
  CONCLUSIONS
  Fifty patients underwent RKT successfully, 7 in the phase 1 and 43 in the phase 2 stages of the study. For the initial 25 patients, mean console, warm ischemia, arterial, and venous anastomotic times were 135, 2.4, 12, and 13.4 min, respectively. All grafts were cooled to 18-20 °C with no change in core body temperature. All grafts functioned immediately posttransplant and the mean serum creatinine level at discharge was 1.3mg/dl (range: 0.8-3.1mg/dl). No patient developed anastomotic leaks, wound complications, or wound infections. At 6-mo of follow-up, no patient had developed a lymphocele detected on CT scanning. Two patients underwent re-exploration, and one patient died of congestive heart failure (1.5 mo posttransplant).
  
  
  CONCLUSIONS
  RKT with regional hypothermia is safe and reproducible when performed by a team skilled in robotic surgery.
  
  
  RESULTS
  RKT is safe and effective when performed by surgeons experienced in robotic techniques.
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA. Electronic address: asood1@hfhs.org.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Mahendra
authors.initials: M
authors.lastname: Bhandari
authors.affiliation: Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India.
authors.forename: Vijay
authors.initials: V
authors.lastname: Kher
authors.affiliation: Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India.
authors.forename: Prasun
authors.initials: P
authors.lastname: Ghosh
authors.affiliation: Department of Urology, Ohio State University, Columbus, OH, USA.
authors.forename: Ronney
authors.initials: R
authors.lastname: Abaza
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Khurshid R
authors.initials: KR
authors.lastname: Ghani
authors.affiliation: Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
authors.forename: Ramesh K
authors.initials: RK
authors.lastname: Kumar
authors.affiliation: Department of Urology, H.L. Trivedi Institute of Transplantation Sciences, Ahmedabad, India.
authors.forename: Pranjal
authors.initials: P
authors.lastname: Modi
authors.affiliation: Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ahlawat
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D007036:Hypothermia, Induced / Q000379:methods*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods*; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D017410:Practice Guidelines as Topic; D011446:Prospective Studies; D012371:Robotics / Q000379:methods*; D052096:Warm Ischemia; D055815:Young Adult
keywords: Hypothermia; IDEAL guidelines; Kidney; Kidney transplantation; Minimally invasive surgery; Robotics