Single Port Robotic Extra-peritoneal Dual Kidney Transplantation: Initial Pre-Clinical Experience and Description of the Technique.

Eltemamy, Mohamed; Garisto, Juan; Miller, Eric; Wee, Alvin; Kaouk, Jihad

OBJECTIVE To describe the surgical technique for single-port robotic extraperitoneal dual kidney transplantation (DKT) using the SP® surgical system (Intuitive Surgical, Sunnyvale, CA, USA) in a pre-clinical model. METHODS In 1 male cadaver the SP® Surgical System was used to perform an extraperitoneal DKT. Kidneys grafts were obtained from the local organ procurement organization after declined by all transplant centers. Kidneys were benched and wrapped in cold sponges. A periumbilical midline incision was performed. A kidney-shaped ballon was inserted through the incision to create the extraperitoneal space. SP robot was docked followed by dissection of iliac vessels bilaterally. The robot was undocked and the first graft was inserted through the wound retractor. The robot was re-docked and the renal vein anastomosis to external iliac vein was performed followed by renal artery anastomosis to external iliac artery using 5-0 monofilament sutures. Ureteroneocystostomy was performed using the Lich-Gregoir technique over a trasplant stent. Same steps were replicated for the left kidney transplant. Once procedures were done, kidneys were then harvested with the iliac vessels to examine the quality of the anastomosis. RESULTS The surgical procedure was completed successfully without the need of additional port or conversion to standard approach. Total bench kidney time was 30 minutes with overall transplantation time of 130 and 115 minutes of the right and left kidney, respectively. CONCLUSION We demonstrated the feasibility of single-port extraperitoneal DKT using the novel SP robotic platform. Limitations include the pre-clinical model. Further assessment is necessary in a truly clinical setting.