TAIPEI, TAIWAN (UroToday.com) - Introduction and Objectives: Minimally invasive approaches to kidney transplantation (KT) have recently been described. We recently developed and described a novel technique of robotic KT (RKT) using intra corporeal graft cooling. We assessed the comparative effectiveness of RKT and open KT (OKT) by evaluating peri and post-operative outcomes.
Methods: From Jan-Dec 2013, a total of 247 patients with end stage renal disease underwent KT at a tertiary referral center of which 225 patients who met the selection criteria were enrolled into this prospective two-arm non-randomized controlled trial (IDEAL Phase-2b). Primary outcome was post transplant graft function. Secondary outcomes measured included surgical and immunologic complications, and peri-operative parameters. All patients had a minimum follow up of 6 months.
Results: Fifty and 175 patients underwent RKT and OKT, respectively. The basic characteristics of the two groups were comparable. Mean serum creatinine at discharge was 1.3 and 1.2mg/dl in RKT and OKT patients respectively (p= 0.71). Post-operative pain and analgesic requirements were significantly less in patients undergoing RKT (p = 0.01).One patient of RKT and 4(2.2%) of OKT needed post transplant dialysis. No lymphocele was detected in protocol non contrast CT done at 3 months in the RKT group (0% vs. 23.8%; p = 0.05). One graft was lost in the OKT group. One patient death in RKT (1.5 months post transplant, cardiac failure) and 2 in OKT group were noted respectively.
Conclusions: RKT with regional hypothermia is safe and easily reproducible. Early outcomes are equivalent to OKT; with trends towards lower complications, quicker graft function recovery and shorter patient convalescence.
Source of Funding: None
|Listen to an interview with Prasun Ghosh, one of the authors of this study.|
Presented by Prasun Ghosh,1 Akshay Sood,2 Vijay Kher,1 Wooju Jeong,2 Ronney Abaza,3 Mahendra Bhandari,2 Mani Menon,2 and Rajesh Ahlawat1 at the 32nd World Congress of Endourology & SWL - September 3 - 7, 2014 - Taipei, Taiwan
1Medanta-The Medicity, India
2Henry Ford Hospital, Detroit, MI USA
3Ohio Health Dublin Methodist Hospital, USA