Intracorporeal Versus Extracorporeal Robot-assisted Kidney Autotransplantation: Experience of the ERUS RAKT Working Group

Abstract

Background: Kidney autotransplantation is a useful technique to be reserved for cases in which kidney function is compromised by a complex anatomical configuration, such as long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction. Robot-assisted kidney autotransplantation (RAKAT) presents a novel, minimally invasive, and highly accurate approach.

Objective: The aim of this study is to present the largest cohort of patients who underwent either extracorporeal (eRAKAT) or intracorporeal (iRAKAT) RAKAT, to confirm safety and feasibility and to compare the two approaches.

Design, setting, and participants: We retrospectively analyzed prospectively followed patients undergoing eRAKAT and totally intracorporeal RAKAT in a total of three institutions.

Surgical procedure: Extracorporeal RAKAT and iRAKAT.

Measurements: Surgical and functional outcomes of patients subjected to eRAKAT and iRAKAT were measured.

Results and limitations: Between January 2017 and February 2021, 29 patients underwent RAKAT: 15 eRAKAT and 14 iRAKAT. No statistical difference in the preoperative data was recorded. The analysis of intraoperative variables showed a statistically significant difference between eRAKAT and iRAKAT in cold ischemia time (median [interquartile range {IQR}]: 151 [125-199] vs 27.5 [20-55]; p < 0.001) and total ischemia time (median [IQR]: 196.2 [182-241] vs 81.5 [73-88]; p < 0.001). However, faster renal function recovery in favor of eRAKAT was observed during the first 90 d, with comparable renal function at 1 yr. The 90-d Clavien-Dindo >2 complications were 13.8%. It is important to stress that RAKAT, and above all iRAKAT, should be performed by surgeons with experience in robotic renal, vascular, and transplant surgery.

Conclusions: Both eRAKAT and iRAKAT represent promising minimally invasive techniques in selected cases with acceptable ischemia time and comparable long-term operative outcomes.

Patient summary: In selected patients, both extra- and intracorporeal robot-assisted kidney autotransplantation represent valid alternatives in case of long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction.

Keywords: Autotransplantation; Extracorporeal; Intracorporeal; Kidney; Kidney autotransplantation; Outcome; Robotic surgery; Technology.