Korean J Transplant.  2023 Nov;37(Suppl 1):S106. 10.4285/ATW2023.F-6884.

Successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience

• Kim HJ

• KMID: 2551726
• DOI: http://doi.org/10.4285/ATW2023.F-6884

Abstract

Background
Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. However, data on the feasibility and safety of performing RKT by surgeons with a lack of prior minimally invasive surgery (MIS) experience are limited. We aimed to evaluate the surgical and functional RKT and present the learning curves (LC) of RKT by a single surgeon with no prior experience in MIS.
Methods
This was a retrospective study of all RKT performed between November 2019 and April 2023 at Severance Hospital in Seoul, Republic of Korea. We analyzed surgical and functional outcomes, as well as complication rates. We evaluated LC using the cumulative summation method to describe the number of cases associated with competency of a single surgeon.
Results
Fifty patients (mean age, 45.1±11.2 years; male:female ratio, 35:15) successfully underwent robotic living donor kidney transplantation. Surgical console time was 201.9±3.4 minutes (range, 118–327 minutes), vascular anastomoses time was 39.1±5.9 minutes (range, 28–58 minutes), and rewarming time was 64.7±12.0 minutes (range, 43–112 minutes). Mean estimated blood loss was 126.0±90.7 mL (range, 50–400 mL). No patient required conversion to open surgery. No anastomosis revision or wound infections occurred. There were no cases of delayed graft function. Mean serum creatinine level at discharge was 1.2±0.3 mg/dL (range, 0.6–2.1 mg/dL). LC analysis revealed that surgical competence was achieved after 15 cases.
Conclusions
RKT with regional hypothermia is a safe and effective minimally invasive alternative to open kidney transplantation, yielding comparable clinical outcomes. Even surgeons without prior robotic or laparoscopic surgery experience can rapidly and effectively overcome the LC