Single port robot-assisted transperitoneal kidney transplant using the sp® surgical system in a pre-clinical model

Abstract

Introduction Minimally invasive surgery has recently gained interest for kidney transplantation. We aimed to describe the step-by-step technique for single-port robotic transperitoneal kidney transplantation using the SP® surgical system (Intuitive Surgical, Sunnyvale, Ca) in a pre-clinical model. Materials and Methods A male fresh cadaver model was placed in a lithotomy position. A 3cm midline incision was made 4cm cephalad to the belly button. An advanced access platform (GelPOINT, Rancho Margarita, California, USA) was inserted into the abdominal cavity through the incision. A left kidney was obtained for the local procurement organization. Bench preparation of the kidney was performed. Thereafter, the organ was introduced transperitoneal through the Alexis® wound retractor. The SP® robotic platform was docked and the pelvic fossa was targeted. The standardized steps of robotic multi-arm kidney transplant were duplicated. Primary outcomes such as intraoperative complications, rate of conversion to standard technique and operative times were recorded. Results The procedure was technically completed using the SP® robotic system without conversion or the need for additional ports. There were no intraoperative complications. The total operative time was 182 minutes, with 35 minutes spent for bench kidney. Conclusions Robotic Single-Port kidney transplantation using the SP® surgical platform is feasible in a pre-clinical model. The platform could be particularly interesting for multi-quadrant surgery such as auto-transplantation, potentially reducing the time for redocking. Further clinical studies in humans and comparison with standard surgical techniques are warranted.