Korean J Transplant.  2023 Sep;37(3):210-215. 10.4285/kjt.23.0021.

Robot-assisted kidney transplantation in a morbidly obese patient with incisional hernia reconstruction and abdominoplasty: a case report

• Kim JM
• Kwon HE
• Ko Y
• Jung JH
• Kwon H
• Kim YH
• Kim EK
• Shin S

• KMID: 2546500
• DOI: http://doi.org/10.4285/kjt.23.0021

Abstract

Performing kidney transplantations in patients with morbid obesity presents unique challenges using the conventional retroperitoneal approach. Robot-assisted kidney transplantation (RAKT) offers several advantages, such as better access to hard-to-reach areas. A 56-year-old morbidly obese woman presented with end-stage renal disease due to diabetic nephropathy. The patient had a history of obesity for over 20 years, with a peak body mass index (BMI) of 46.9 kg/m2. Before transplantation, she successfully reduced her BMI to 28.9 kg/m2, but was left with excessive skin folds. The surgery began with the removal of the sac from the incisional hernia and umbilical hernia, which was then used as the site for the GelPOINT port. The da Vinci X robot system was utilized to perform RAKT. After completing RAKT, the plastic surgery team initiated abdominal reconstruction involving panniculectomy, followed by hernial reconstruction and abdominoplasty. The patient’s postoperative course was uneventful, and she was discharged on postoperative day 7. Her creatinine level was 0.69 mg/dL, and she did not experience any episodes of rejection during the 16 months following RAKT. This case report describes the successful combination of RAKT with incisional hernia reconstruction and abdominoplasty in a patient with morbid obesity.

Keyword

Robot-assisted kidney transplantation; Morbid obesity; Incisional hernia; Abdominoplasty

Figure

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  Fig. 1 Computed tomography abdominal scan showing the incisional hernia (4.3 cm) with a defect in the right lower abdominal wall.

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  Fig. 2 A schematic diagram showing the trocar placement, incisional hernia area, and abdominoplasty design line.

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  Fig. 3 Intraoperative snapshots showing the main phases of (A) venous and (B) arterial anastomosis and (C) ureteroneocystostomy during robot-assisted kidney transplantation.

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  Fig. 4 (A) Incisional hernia from the previous hysterectomy wound with large panniculus. (B) Primary fascial repair after separation of components.

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