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Review
. 2021 Nov 15;15(4):635-643.
doi: 10.1093/ckj/sfab214. eCollection 2022 Apr.

Robot-assisted kidney transplantation: an update

Harry V M Spiers  1 , Videha Sharma  2 , Alexander Woywodt  3 , Rajesh Sivaprakasam  4 , Titus Augustine  2
Affiliations
Review

Robot-assisted kidney transplantation: an update

Harry V M Spiers et al. Clin Kidney J. .

Abstract

Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.

Keywords: chronic renal failure; minimally invasive surgery; obesity; renal transplant; robot-assisted kidney transplant.

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Figures

Figure 1:
Figure 1:
End-to-side venous anastomosis of donor renal vein to recipient external iliac vein. While performed robotically here, the technique is the same for open kidney transplant. (A) Initial stay suture. (B) Completion of back wall. (C) Complete anastomosis. RV, renal vein; EIV, external iliac vein; EIA, external iliac artery; GK, graft kidney.
Figure 2:
Figure 2:
End-to-side arterial anastomosis of donor renal artery to recipient external iliac artery. While performed robotically here, the technique is the same for open kidney transplant. (A) Initial stay sutures. (B) Completion of back wall. (C) Complete anastomosis. (D) Anastomosis and graft post-reperfusion. RA, renal artery; EIA, external iliac artery; EIV, external iliac vein; GK, graft kidney.
Figure 3:
Figure 3:
Creation of ureteroneocystostomy. While performed robotically here, the technique is the same for open kidney transplant. (A) Recipient bladder filled with methylene blue with mucosa seen under reflected serosa. (B) Anastomosis of recipient bladder mucosa with donor ureter. BM, bladder mucosa; S, serosa; U, donor ureter.
Figure 4:
Figure 4:
Robotic systems established in clinical practice. (A) Hugo Robotic System by Medtronic. (B) Versius by CMR Surgical. (C) The da Vinci surgical system by Intuitive Surgical.
See this image and copyright information in PMC

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