Robotic Donor Nephrectomy

Laparoscopic donor nephrectomy is the new gold standard for kidney donation at many transplant centers. The development of laparoscopic donor nephrectomy has been revolutionary, yet increased operating room time and retrieval of shorter donor vessels especially in the early learning curve have been suggested as technical concerns (18,19). With the introduction of telerobotic surgical systems, some investigators have hypothesized that the enhanced dexterity and improved optics of systems like da Vinci may remedy reported technical concerns and thereby improve operative performance of laparoscopic donor nephrectomy. Using this premise, the initial clinical series of robot-assisted donor nephrectomies were reported by Horgan et al. in 2002 (18).

The indications and operative techniques for robotic donor nephrectomy are similar to those used for the standard laparoscopic procedure; however, to date the robotic technique has been utilized only for left donor nephrectomies. Robotic donor nephrectomy also utilizes both the da Vinci robotic system and the laparoscopic handassist device (18,19). After placing the patient in a 45° lateral decubitus position, a 7 cm infraumbilical incision is first made for the hand-port device, and four trocars (two reusable robotic trocars and two 10 mm standard trocars) are then positioned on the left side of the abdomen. During the robotic procedure, the assistant surgeon performs important standard laparoscopic maneuvers including retraction and exposure, division of the renal artery and vein, and removal of the kidney through the hand-port device.

In the initial report of 10 patients undergoing robot-assisted laparoscopic donor nephrectomy, Horgan et al. reported a mean operative time of 166 minutes and a mean estimated blood loss of 68 mL (18). The mean warm ischemia time was 85 seconds and all kidneys were functional upon transplantation. There were no intraoperative complications and no open conversions. In a related report, Horgan et al. compared the results of 12 robotic donor nephrectomies to 23 standard laparoscopic donor nephrectomies and 25 open donor nephrectomies (19). While the mean operative time was 50 minutes longer using the robotic technique, the authors reported multiple technical advantages including a three-dimensional view of the operative field and enhanced dexterity, which improved dissection of the vessels and allowed early identification of the ureter. The authors also reported that dissection of the upper pole was simplified by the articulating wrists of the da Vinci system (19).

0 0

Post a comment