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Emerging role of Robot in Renal Transplant Surgery

Dr. Anup Gupta
National Convener of Organ Donation promotion program NOTTO
National Technical Expert of Advisory Committee NOTTO

Robot-assisted kidney transplant (RAKT) has emerged as a groundbreaking advancement in the field of transplantation surgery. The first full RAKT was reported in a morbidly obese patient by Giulianotti et al. (1) from Chicago in 2010. RAKT combines the precision of robotic systems (DaVinci, Intuitive Surgical, Sunnyvale, CA, USA) with the expertise of skilled surgeons to enhance the overall procedure. Unlike traditional open renal transplant surgery, RAKT utilize minimally invasive techniques, resulting in smaller incisions, reduced blood loss, lesser post-operative pain and quicker recovery times for patients. The enhanced visualization with highdefinition 3D imaging provides a magnified view of the surgical site and the robot's articulated arms provide unparalleled dexterity and remarkable precision, ultimately leading to improved graft placement and vascular anastomosis. RAKT also improves access to renal transplant in obese patients and have low wound complication rates

(3.8%) in obese individuals. (2) Recent study from India with a median follow up of 5 years has shown that RAKT outcomes are non-inferior to open transplant. (3) Technical modifications, experience and expertise would further improve the RAKT overall outcomes. Learning curve for RAKT is short, which is easily achievable (4) and surgeons already performing renal transplants and robotic surgeries will be able to learn even faster. With the increasing number of transplant and Robotic centers in India, RAKT would be increasing in number and also act as a testament to the remarkable strides in surgical innovation.

References:

  1. Giulianotti PC, Bianco FM, Addeo P, Lombardi A, Coratti A, Sbrana F. Robot-assisted laparoscopic repair of renal artery aneurysms. J Vasc Surg. 2010;51:842–9
  2. Patil A, Ganpule A, Singh A, Agrawal A, Patel P, Shete N, Sabnis R, Desai M. Robot-assisted versus conventional open kidney transplantation: a propensity matched comparison with median follow-up of 5 years. American Journal of Clinical and Experimental Urology. 2023;11(2):168.
  3. Tzvetanov IG, Spaggiari M, Tulla KA, Di Bella C, Okoye O, Di Cocco P, Jeon H, Oberholzer J, Cristoforo Giulianotti P, Benedetti E. Robotic kidney transplantation in the obese patient: 10‐year experience from a single center. American Journal of Transplantation. 2020 Feb;20(2):430-40.
  4. Gallipoli A, Territo A, Boissier R, Campi R, Vignolini G, Musquera M, Alcaraz A, Decaestecker K, Tugcu V, Vanacore D, Serni S. Learning curve in robot-assisted kidney transplantation: results from the European Robotic Urological Society Working Group. European urology. 2020 Aug 1;78(2):239-47.

PHOTO CAPTION

  1. a) Transplant bed created transperitoneal by exposing external renal artery and vein
  2. b) Renal Vein to External iliac vein anastomosis showing excellent visualisation
  3. c) Renal Artery to External Iliac artery anastomosis showing excellent visualisation
  4. d) Intraop Renal Doppler confirming established vascularity post vascular anastomosis
  5. e) Peritoneum placed and clipped over the Renal graft to prevent flipping of the graft
  6. f) Picture comparing Robotic and Open Kidney transplant scar