Robotic Kidney Transplantation with Regional Hypothermia: A Step-by-step Description of the Vattikuti Urology Institute-Medanta Technique (IDEAL Phase 2a)

被引:143
作者
Menon, Mani [1 ]
Sood, Akshay [1 ]
Bhandari, Mahendra [1 ]
Kher, Vijay [2 ]
Ghosh, Prasun [2 ]
Abaza, Ronney [3 ]
Jeong, Wooju [1 ]
Ghani, Khurshid R. [1 ]
Kumar, Ramesh K. [1 ]
Modi, Pranjal [4 ]
Ahlawat, Rajesh [2 ]
机构
[1] Henry Ford Hosp, Vattikuti Urol Inst, Detroit, MI 48202 USA
[2] Medanta Med, Kidney & Urol Inst, Gurgaon, India
[3] Ohio State Univ, Dept Urol, Columbus, OH 43210 USA
[4] HL Trivedi Inst Transplantat Sci, Dept Urol, Ahmadabad, Gujarat, India
关键词
Robotics; Minimally invasive surgery; Kidney; Kidney transplantation; Hypothermia; IDEAL guidelines; RENAL-TRANSPLANTATION; DONOR NEPHRECTOMY; PROSTATECTOMY; SURVIVAL; OUTCOMES; GRAFT;
D O I
10.1016/j.eururo.2013.12.006
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Background: We recently reported on preclinical and feasibility studies (Innovation, Development, Exploration, Assessment, Long-term study [IDEAL] phase 0-1) of the development of robotic kidney transplantation (RKT) with regional hypothermia. This paper presents the IDEAL phase 2a studies of technique development. Objectives: To describe the technique of RKT with regional hypothermia developed at two tertiary care institutions (Vattikuti Urology Institute and Medanta Hospital). We report on the safety profile and early graft function in these patients. Design, setting, and participants: This is a prospective study of 50 consecutive patients who underwent live-donor RKT at Medanta Hospital following a 3-yr planning/simulation phase at the Vattikuti Urology Institute. Demographic details, and perioperative and postoperative outcomes are reported for the initial 25 recipients who have completed a minimum 6-mo follow-up. Surgical procedure: Positioning and port placement were similar to that used for robotic radical prostatectomy. Allograft cooling was achieved by ice slush delivered through a GelPOINT device. The accompanying video details the operative technique. Outcome measurements and statistical analysis: The primary outcome was posttransplant graft function. Secondary outcomes included technical success or failure and complication rates. Results and limitations: Fifty patients underwent RKT successfully, 7 in the phase 1 and 43 in the phase 2 stages of the study. For the initial 25 patients, mean console, warm ischemia, arterial, and venous anastomotic times were 135, 2.4, 12, and 13.4 min, respectively. All grafts were cooled to 18-20 degrees C with no change in core body temperature. All grafts functioned immediately posttransplant and the mean serum creatinine level at discharge was 1.3 mg/dl (range: 0.8-3.1 mg/dl). No patient developed anastomotic leaks, wound complications, or wound infections. At 6-mo of follow-up, no patient had developed a lymphocele detected on CT scanning. Two patients underwent re-exploration, and one patient died of congestive heart failure (1.5 mo posttransplant). Conclusions: RKT with regional hypothermia is safe and reproducible when performed by a team skilled in robotic surgery. (C) 2013 European Association of Urology. Published by Elsevier B.V. All rights reserved.
引用
收藏
页码:991 / 1000
页数:10
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