Abstract
The indications for renal autotransplantation (RATx) include renal vascular trauma, thrombosis, stenosis, aneurysm, complex ureteral injuries, renal cell carcinoma, urolithiasis, retroperitoneal fibrosis, and loin pain-hematuria syndrome. Unfortunately, RATx is underutilized because of its invasiveness. The current gold standard approach to RATx is laparoscopic nephrectomy and open autotransplantation, which requires a large pelvic incision. Robotic-assisted renal autotransplantation (robotic RATx) is a new, minimally invasive approach that has been used since 2014. The first completely intracorporeal robotic RATx, used to repair a ureteral injury, was reported in 2014. Since then, only three cases have been reported, all from North America. After an initial porcine study, we conducted the fourth robotic RATx procedure. Robotic surgery has multiple advantages, such as providing a three-dimensional magnified view, navigating in narrow spaces, and fine suturing and dissection, which are particularly helpful in cases with desmoplastic changes. Most robotic RATx procedures have been used to repair ureteral injuries. These cases tend to have desmoplastic changes due to previous surgeries. Nephrectomy and RATx are technically challenging, hence robotic surgery may be the best option in patients with complex and severe desmoplastic changes. The disadvantages of robotic RATx include the length of surgery and cost. However, with continued use, both the operative time and the cost should decrease. In conclusion, robotic RATx is a new, minimally invasive approach to renal preservation.
Access this chapter
Tax calculation will be finalised at checkout
Purchases are for personal use only
Similar content being viewed by others
References
Araki, M, Wada K, Mitsui Y, Sadahira T, Kubota R, Nishimura S, et al. Robotic renal autotransplantation: first case outside of North America. Acta Med Okayama 2017;71(4):351–55.
Bluebond-Langner R, Rha KH, Pinto PA, Varkarakis J, Douyon E, Komotar RJ, et al. Laparoscopic-assisted renal autotransplantation. Urology. 2004;63(5):853–6. https://doi.org/10.1016/j.urology.2003.12.019.
Gill IS, Abreu SC, Desai MM, Steinberg AP, Ramani AP, Ng C, et al. Laparoscopic ice slush renal hypothermia for partial nephrectomy: the initial experience. J Urol. 2003;170(1):52–6. https://doi.org/10.1097/01.ju.0000072332.02529.10.
Giulianotti P, Gorodner V, Sbrana F, Tzvetanov I, Jeon H, Bianco F, et al. Robotic transabdominal kidney transplantation in a morbidly obese patient. Am J Transplant. 2010;10(6):1478–82. https://doi.org/10.1111/j.1600-6143.2010.03116.x.
Gordon ZN, Angell J, Abaza R. Completely intracorporeal robotic renal autotransplantation. J Urol. 2014;192(5):1516–22. https://doi.org/10.1016/j.juro.2014.02.2589.
Hardy JD, Eraslan S. Autotransplantation of the kidney for high ureteral injury. J Urol. 1963;90:563–74.
Hoznek A, Zaki SK, Samadi DB, Salomon L, Lobontiu A, Lang P, et al. Robotic assisted kidney transplantation: an initial experience. J Urol. 2002;167(4):1604–6.
Janetschek G, Abdelmaksoud A, Bagheri F, Al-Zahrani H, Leeb K, Gschwendtner M. Laparoscopic partial nephrectomy in cold ischemia: renal artery perfusion. J Urol. 2004;171(1):68–71. https://doi.org/10.1097/01.ju.0000101040.13244.c4.
Landman J, Venkatesh R, Lee D, Vanlangendonck R, Morissey K, Andriole GL, et al. Renal hypothermia achieved by retrograde endoscopic cold saline perfusion: technique and initial clinical application. Urology. 2003;61(5):1023–5. https://doi.org/10.1016/S0090-4295(02)02566-9.
Lee J, Ordon M. Innovative applications of robotic surgery: renal allograft and autologous transplantation. F1000Res. 2016;5. https://doi.org/10.12688/f1000research.7343.1.
Lee JY, Alzahrani T, Ordon M. Intra-corporeal robotic renal auto-transplantation. Canadian Urol Assoc J. 2015;9(9–10):E748–9. https://doi.org/10.5489/cuaj.3015.
Levey AS, Coresh J. Chronic kidney disease. Lancet. 2012;379(9811):165–80. https://doi.org/10.1016/S0140-6736(11)60178-5.
Menon M, Sood A, Bhandari M, Kher V, Ghosh P, Abaza R, et al. Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a). Eur Urol. 2014a;65(5):991–1000. https://doi.org/10.1016/j.eururo.2013.12.006.
Menon M, Abaza R, Sood A, Ahlawat R, Ghani KR, Jeong W, et al. Robotic kidney transplantation with regional hypothermia: evolution of a novel procedure utilizing the IDEAL guidelines (IDEAL phase 0 and 1). Eur Urol. 2014b;65(5):1001–9. https://doi.org/10.1016/j.eururo.2013.11.011.
Meraney AM, Gill IS, Kaouk JH, Skacel M, Sung GT. Laparoscopic renal autotransplantation. J Endourol. 2001;15(2):143–9. https://doi.org/10.1089/089277901750134403.
Navarro AP, Sohrabi S, Colechin E, Griffiths C, Talbot D, Soomro NA. Evaluation of the ischemic protection efficacy of a laparoscopic renal cooling device using renal transplantation viability assessment criteria in a porcine model. J Urol. 2008;179(3):1184–9. https://doi.org/10.1016/j.juro.2007.10.025.
Oberholzer J, Giulianotti P, Danielson KK, Spaggiari M, Bejarano-Pineda L, Bianco F, et al. Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation. Am J Transplant. 2013;13(3):721–8. https://doi.org/10.1111/ajt.12078.
Ratner LE, Kavoussi LR, Schulam PG, Bender JS, Magnuson TH, Montgomery R. Comparison of laparoscopic live donor nephrectomy versus the standard open approach. Transplant Proc. 1997;29(1–2):138–9.
Snyder JJ, Collins AJ. Association of preventive health care with atherosclerotic heart disease and mortality in CKD. J Am Soc Nephrol. 2009;20(7):1614–22. https://doi.org/10.1681/ASN.2008090954.
Stevens PE, Levin A, Kidney Disease: Improving Global Outcomes Chronic Kidney Disease Guideline Development Work Group Members. Evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline. Ann Intern Med. 2013;158(11):825–30. https://doi.org/10.7326/0003-4819-158-11-201306040-00007.
Tsai MK, Lee CY, Yang CY, Yeh CC, Hu RH, Lai HS. Robot-assisted renal transplantation in the retroperitoneum. Transplant Int. 2014;27(5):452–7. https://doi.org/10.1111/tri.12279.
Veeratterapillay R, Addla SK, Jelley C, Bailie J, Rix D, Bromage S, et al. Early surgical outcomes and oncological results of robot-assisted partial nephrectomy: a multicentre study. BJU Int 2016. doi:https://doi.org/10.1111/bju.13743.
Weld KJ, Koziol S, Montiglio C, Sorenson P, Cespedes RD, Bishoff JT. Feasibility of laparoscopic renal cooling with near-freezing saline irrigation delivered with a standard irrigator aspirator. Urology. 2007;69(3):465–8. https://doi.org/10.1016/j.urology.2006.12.002.
Wotkowicz C, Libertino JA. Renal autotransplantation. BJU Int. 2004;93(3):253–7.
Author information
Authors and Affiliations
Corresponding author
Editor information
Editors and Affiliations
Rights and permissions
Copyright information
© 2019 Springer Nature Singapore Pte Ltd.
About this chapter
Cite this chapter
Araki, M. et al. (2019). Robotic-Assisted Renal Autotransplantation: Preliminary Studies and Future Directions. In: Chan, Ey., Matsuda, T. (eds) Endourology Progress. Springer, Singapore. https://doi.org/10.1007/978-981-13-3465-8_18
Download citation
DOI: https://doi.org/10.1007/978-981-13-3465-8_18
Published:
Publisher Name: Springer, Singapore
Print ISBN: 978-981-13-3464-1
Online ISBN: 978-981-13-3465-8
eBook Packages: MedicineMedicine (R0)