title: Minimally invasive kidney transplantation: perioperative considerations and key 6-month outcomes.
abstract: BACKGROUND
  Minimally invasive approaches to kidney transplantation (KT) have been described recently. However, information concerning perioperative management in these patients is lacking. Accordingly, in the current study, we describe our perioperative management strategy in patients undergoing robotic KT with regional hypothermia and report its safety and efficacy. Further, we describe key 6-month outcomes in these patients.
  
  
  METHODS
  Sixty-seven consecutive end-stage renal disease patients underwent live-donor robotic KT at a single tertiary care institution between January 2013 and June 2014. Outcomes including patient/graft survival, graft function, operative parameters, and perioperative complications are reported in patients with a minimum of 6-month follow-up (n=54).
  
  
  RESULTS
  All patients successfully underwent robotic KT with regional hypothermia using a modified intraoperative management protocol. None of the cases required conversion to open surgery (0%). Mean console, warm ischemia, and rewarming times were 130.8 minutes, 2.3 minutes and 42.9 minutes, respectively. Mean graft-surface temperature was 19.2°C with zero incidence of systemic hypothermia. Routine extraperitonealization of the graft insured against graft-torsion (0%) despite a transperitoneal approach to graft placement. There were no instances of graft vascular thromboses/stenoses/leaks (0%). Three patients (5.6%) developed clinical head-neck edema but were successfully extubated on table. There was no delayed graft function (0%). Mean 6-month serum creatinine was 1.2 mg/dL. Patient survival was 96.3% (n=52), and death-censored graft survival was 100% at a median follow-up of 13.4 months.
  
  
  CONCLUSIONS
  Significant differences exist in intraoperative management of patients undergoing robotic KT and open KT. By tweaking fluid infusion rates and pneumatic pressures and maintaining core body temperature, optimal patient outcomes can be achieved. Pretransplant and posttransplant management is essentially the same.
authors.affiliation: 1 Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI. 2 Kidney and Urology Institute, Medanta, Medicity, Gurgaon, India. 3 Department of Anesthesiology, Medanta, Medicity, Gurgaon, India.
authors.forename: Akshay
authors.initials: A
authors.lastname: Sood
authors.forename: Prasun
authors.initials: P
authors.lastname: Ghosh
authors.forename: Wooju
authors.initials: W
authors.lastname: Jeong
authors.forename: Sangeeta
authors.initials: S
authors.lastname: Khanna
authors.forename: Jyotirmoy
authors.initials: J
authors.lastname: Das
authors.forename: Mahendra
authors.initials: M
authors.lastname: Bhandari
authors.forename: Vijay
authors.initials: V
authors.lastname: Kher
authors.forename: Rajesh
authors.initials: R
authors.lastname: Ahlawat
authors.forename: Mani
authors.initials: M
authors.lastname: Menon
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005440:Fluid Therapy; D006085:Graft Survival; D006801:Humans; D007036:Hypothermia, Induced; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D007194:India; D007676:Kidney Failure, Chronic / Q000601:surgery*; D016030:Kidney Transplantation / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010535:Laparoscopy / Q000009:adverse effects / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000517:prevention & control; D012307:Risk Factors; D012371:Robotics; D025321:Surgery, Computer-Assisted / Q000009:adverse effects / Q000401:mortality; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D052096:Warm Ischemia; D055815:Young Adult
chemical_list: D007166:Immunosuppressive Agents