MP76-15 ROBOT-ASSISTED KIDNEY AUTOTRANSPLANTATION (RAKAT): UPDATE FROM THE FIRST SERIES IN EUROPE

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery III (MP76)1 Apr 2019MP76-15 ROBOT-ASSISTED KIDNEY AUTOTRANSPLANTATION (RAKAT): UPDATE FROM THE FIRST SERIES IN EUROPE Benjamin Van Parys*, Jeroen Van Besien, Nicolas Doumerc, Liesbeth Desender, Caren Randon, Frederic De Ryck, Thomas Tailly, Matthias Beysens, Carl Van Haute, Diederik Ponette, Kathia De Man, Piet Hoebeke, Frank Vermassen, and Karel Decaestecker Benjamin Van Parys*Benjamin Van Parys* More articles by this author , Jeroen Van BesienJeroen Van Besien More articles by this author , Nicolas DoumercNicolas Doumerc More articles by this author , Liesbeth DesenderLiesbeth Desender More articles by this author , Caren RandonCaren Randon More articles by this author , Frederic De RyckFrederic De Ryck More articles by this author , Thomas TaillyThomas Tailly More articles by this author , Matthias BeysensMatthias Beysens More articles by this author , Carl Van HauteCarl Van Haute More articles by this author , Diederik PonetteDiederik Ponette More articles by this author , Kathia De ManKathia De Man More articles by this author , Piet HoebekePiet Hoebeke More articles by this author , Frank VermassenFrank Vermassen More articles by this author , and Karel DecaesteckerKarel Decaestecker More articles by this author View All Author Informationhttps://doi.org/10.1097/01.JU.0000557307.93315.ccAboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVES: Kidney autotransplantation (KAT) is the ultimate way to salvage kidneys with complex renovascular, ureteral or malignant pathologies that are not amendable to in situ reconstruction. Minimal invasive approach could broaden its adoption, due to the lower morbidity and high quality of anastomosis. We give an update of perioperative parameters and early (3 months) functional outcomes of the first robot-assisted kidney autotransplantation (RAKAT) series. METHODS: 10 patients underwent RAKAT (male/female 3/7; left/right 8/2), for complex ureteral strictures (8), severe left renal vein nutcracker (1) and loin-pain hematuria syndrome (1), between March 2017 and September 2018. Alternatives discussed with the patients were laparoscopic nephrectomy, Boari flap and ileal interposition. All patients gave written informed consent. In 9 patients the kidney was exteriorised for preparation on the bench; 2 patients underwent table top vascular reconstruction and 1 ex vivo flexible ureteroscopy to extract a 6 mm lower pole lithiasis. The technique is presented in the enclosed figure. RESULTS: RAKAT was successful in all patients. Mean operative and console time was 405 and 304 min with median vascular and ureteral anastomosis time 25 and 23 min. Median warm, cold and rewarming ischemia time was 3, 175 and 48 min respectively. No patient needed open conversion. 3 patients had a major 90d postoperative complication (grade 3b): wound dehiscence needing wound revision, stent dislodgment needing repositioning and left calf compartment syndrome needing fasciotomy without lasting disability. Median hospital stay was 6 days. At 3 months, all patients were free of indwelling stents, pain or hematuria and showed good vascularisation and absence of hydronephrosis of the autograft on ultrasound. Nuclear DMSA and Cr-EDTA scans 3 months postop showed no transplant kidney function loss in 5, a significant GFR drop in 2 and a significant GFR increase in 3 autotransplants. CONCLUSIONS: We describe the first series of a minimal invasive technique for KAT. RAKAT is a promising approach to salvage kidneys in selected patients with complex and disabling ureteral or renal pathology. RAKAT resolves the disabling symptoms and results in good function of the autotransplant at 3 months. Source of Funding: none Ghent, Belgium; Toulouse, France; Ghent, Belgium; Ostend, Belgium; Ghent, Belgium© 2019 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 201Issue Supplement 4April 2019Page: e1128-e1129 Advertisement Copyright & Permissions© 2019 by American Urological Association Education and Research, Inc.MetricsAuthor Information Benjamin Van Parys* More articles by this author Jeroen Van Besien More articles by this author Nicolas Doumerc More articles by this author Liesbeth Desender More articles by this author Caren Randon More articles by this author Frederic De Ryck More articles by this author Thomas Tailly More articles by this author Matthias Beysens More articles by this author Carl Van Haute More articles by this author Diederik Ponette More articles by this author Kathia De Man More articles by this author Piet Hoebeke More articles by this author Frank Vermassen More articles by this author Karel Decaestecker More articles by this author Expand All Advertisement PDF downloadLoading ...