EAU 2019: Results of the 50 First Cases of Robotic Assisted Kidney Transplantation Compared to Matched-Pair Open Cases

Barcelona, Spain (UroToday.com) Compared to open surgery, robotic surgery allows smaller incisions, pain and scars reduction, less time spent in the hospital and faster recovery times. Surgeons also benefit by gaining enhanced precision, flexibility, control and vision allowing them to perform difficult surgical maneuvers such as intracorporeal vascular anastomosis. Hence, the use of the robot was considered in kidney transplantation and the aim of this study is to compare the results of the 50 first robotic-assisted kidney transplantations (RAKT) with matched pair of open ones (OKT).

Prospectively collected charts of 50 patients were matched based on recipient and donor age, sex and BMI, preemptive transplant condition, and ABO compatibility to patients who underwent the open technique.

No differences in BMI, donor-recipient relationship, preemptive condition, ABO compatibility, and warm ischemia time existed between both cohorts. Results showed that both groups had similar number of multi-vessel grafts (5 for RAKT, 6 for OKT), similar number of transplantectomy performed in both groups due to thrombosis (1 in each), no statistically significant difference regarding creatinine curve evolution, no statistically significant difference was detected in hospitalization days, and no difference in the graft survival after almost 4 years of follow up.

When it comes to differences, the RAKT group had higher operative time (p<0.05), lower transfusion rate (p=0.08), lower postoperative haematuria (p=0.008), lower eventration rate, lower seroma formation, and less ureterovesical anastomosis complications (p=0.05). In the renal scintigraphy study, the RAKT group presented a significant lower tracer transit time (p<0.005) which explains why it had a lower tracer uptake (p= 0.01).

In the RAKT group, two complications were reported: two cases had to switch to open surgery because of abnormal perfusion. One case spontaneously resolved and the other one required graft revascularization because of a problem with the bench end-to-side artery anastomosis. In the OKT group, one case developed arterial kinking which needed surgical intervention.

With these results, the RAKT approach looks promising and can pave the way for larger and bigger trials.

Presented by: T. Ajami Fardoun, Hospital Clinic de Barcelona, Department of Urology, Barcelona, Spain

Written by: Farouk M. El-Khatib, MD – Clinical Research Fellow, UC Irvine Health, Department of Urology at the 34th European Association of Urology (EAU 2019) #EAU19 conference in Barcelona, Spain, March 15-19, 2019.