title: First Robotic-Assisted Dual Kidney Transplant: Surgical Technique and Report of a Case With 24-month Follow-up.
abstract: BACKGROUND
  Open surgery is the gold standard procedure for kidney transplantation. There is a strong rationale for using minimally invasive surgery in patients with end-stage renal disease. A robotic-assisted dual kidney transplant was performed for the first time at our institution.
  
  
  METHODS
  In August 2013, a 63-year-old man with end-stage renal disease and diabetes mellitus under pharmacological control received both kidneys from a 70-year-old marginal donor. Pretransplant donor biopsy demonstrated a bilateral Karpinski score greater than 5. The organs did not exhibit malformations and each had an artery and a vein. The procedure was carried out by a 7-port intraperitoneal approach using the da Vinci surgical system. The procedure was identical for the 2 kidneys except that mobilization of the sigmoid colon was required to introduce the left graft. The renal vessels were anastomosed to the left external iliac vessels. The novel aspect of the technique was the introduction of both grafts through a single, 7-cm upper midline incision.
  
  
  RESULTS
  Total operative time was 400 minutes and blood loss was 120 mL. Both grafts immediately began functioning. There were no intraoperative or postoperative complications. The patient was discharged on the seventh postoperative day with normal renal function. At 24 months, he is well and does not require hemodialysis.
  
  
  CONCLUSIONS
  Minimally invasive robotic-assisted technology is a promising technique that provides exceptional patient outcomes by reducing operative morbidity, immobilization, and time to recovery, while affording better esthetic results. Selected patients with multiple comorbidities benefit most. Grafts from marginal donors are an extremely valuable resource.
authors: Department of Renal Pathology, Urology, Kidney Transplantation and Robotic Surgery Unit, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy.
authors: Mauro
authors: M
authors: Frongia
authors: Department of Renal Pathology, Urology, Kidney Transplantation and Robotic Surgery Unit, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy.
authors: Rossano
authors: R
authors: Cadoni
authors: Department of Renal Pathology, Urology, Kidney Transplantation and Robotic Surgery Unit, Azienda Ospedaliera "G. Brotzu", Cagliari, Italy.
authors: Andrea
authors: A
authors: Solinas