Introduction and Objectives: Kidney autotransplantation can be performed in patients with complex renal or ureteral pathology not suitable for in situ reconstruction, such as renal vasculature anomalies, patients with proximal or long complex ureteral strictures, or complex oncological cases. Robot-assisted surgery allows for a high-quality vascular and ureteral anastomosis and faster patient recovery. Robot-assisted kidney autotransplantation (RAKAT) is performed in two phases: nephrectomy and pelvic transplantation. In-between, extraction of the kidney allows for vascular reconstruction or kidney modification on the bench and safe cold ischemia can be established. If no bench reconstruction is needed, total intracorporeal RAKAT (tiRAKAT) is feasible. One case report in Europe has been described; however, to our knowledge no surgical video is available. Methods: A 58 year-old woman suffered from right mid- and distal ureteral stenosis following pelvic radiotherapy 10 years prior for cervical cancer. A JJ stent was placed, but she suffered from recurrent urinary tract infections, and ultimately a nephrostomy was placed. Renogram demonstrated 43% relative right kidney function. As her bladder volume was low following radiotherapy, no Boari flap was possible and the patient refused life-long nephrostomy or nephrectomy. Therefore, tiRAKAT was performed using the DaVinci Xi system. Results: We describe our surgical technique including a video. Surgical time (skin-to-skin) was 5 h and 45 min. Warm ischemia time was 4 min, cold ischemia 55 min, and rewarming ischemia 15 min. The abdominal catheter and bladder catheter were removed on the first and second postoperative day, respectively. The JJ stent was removed after 4 weeks. The patient suffered from pulmonary embolism on the second postoperative day, for which therapeutic low molecular weight heparin was started. No further complications occurred during the first 90 postoperative days. After 7 months, overall kidney function remained stable, right kidney function dropped non-significantly from 27 to 25.2 mL/min (−6.7%) on renal scintigraphy. Conclusion: We demonstrated feasibility and, for the first time, a surgical video of tiRAKAT highlighting patient positioning, trocar placement, and intracorporeal cold ischemia technique.

Autotransplantation

Nephrostomy

10.3389/fsurg.2020.00065

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Citations (6)

V11-02 TOTALLY INTRACORPOREAL ROBOT-ASSISTED KIDNEY AUTO-TRANSPLANTATION

The Journal of Urology (2020)

C. Van Praet Benjamin Van Parys Liesbeth Desender Karel Decaestecker

You have accessJournal of UrologyTransplant, Misc GU Cancers & Bladder Reconstruction (non-cancer) (V11)1 Apr 2020V11-02 TOTALLY INTRACORPOREAL ROBOT-ASSISTED KIDNEY AUTO-TRANSPLANTATION Charles Van Praet*, Benjamin Van Parys, Liesbeth Desender, and Karel Decaestecker Charles Van Praet*Charles Van Praet* More articles by this author , Benjamin Van ParysBenjamin Van Parys More articles by this author , Liesbeth DesenderLiesbeth Desender More articles by this author , and Karel DecaesteckerKarel Decaestecker More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000945.02AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Kidney auto-transplantation can be performed in patients with complex renal or ureteral pathology not suitable for in situ reconstruction, such as renal vasculature anomalies, patients with proximal or long complex ureteral strictures or complex oncological cases. Robot-assisted surgery allows for a high-quality vascular and ureteral anastomosis and faster patient recovery. Robot-assisted kidney auto-transplantation (RAKAT) is performed in 2 phases: nephrectomy and pelvic transplantation. In-between, extraction of the kidney allows for vascular reconstruction or kidney modification on the bench and safe cold ischemia can be established. If no bench reconstruction is needed, totally intracorporeal RAKAT (tiRAKAT) is feasible. One case report in Europe has been described, however, to our knowledge no surgical video is available. In our surgical video, we demonstrate the procedure with attention to patient and trocar positioning, establishing intracorporeal cold ischemia and the advantages of the DaVinci Xi system with boom rotation for this specific procedure. METHODS: A 58 year old woman suffered from right distal ureter stenosis following pelvic radiotherapy 10 years prior for cervical cancer. A double J stent was placed, but she suffered from recurrent urinary tract infections and ultimately a nephrostomy was placed. Renogram demonstrated 43% relative right kidney function. As her bladder volume was low following radiotherapy, no Boari flap was possible and the patient refused life-long nephrostomy and nephrectomy. Therefore, tiRAKAT was performed, using the DaVinci Xi system. RESULTS: Surgical time (skin-to-skin) was 5 hours and 45 minutes. Warm ischemia time was 4 minutes, cold ischemia 55 minutes and rewarming ischemia 15 minutes. The abdominal catheter and bladder catheter were removed on the first and second postoperative day, respectively. The double J stent was removed after 3 weeks. The patient suffered from pulmonary embolism on the second postoperative day, for which therapeutic low molecular weight heparin was started. No further complications occurred during the first 30 postoperative days. CONCLUSIONS: We demonstrated feasibility and, for the first time, a surgical video of tiRAKAT highlighting patient positioning and trocar placement and intracorporeal cold ischemia technique. Source of Funding: None. © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e1014-e1015 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Charles Van Praet* More articles by this author Benjamin Van Parys More articles by this author Liesbeth Desender More articles by this author Karel Decaestecker More articles by this author Expand All Advertisement PDF downloadLoading ...

Karel

10.1097/ju.0000000000000945.02

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

European Urology (2021)

Alberto Breda Pietro Diana Angelo Territo Andrea Gallioli Alberto Piana

Interquartile range

Autotransplantation

Extracorporeal

10.1016/j.eururo.2021.07.023

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Citations (28)

Robot-Assisted Kidney Transplantation

IntechOpen eBooks (2020)

Karel Decaestecker Angelo Territo Riccardo Campi Benjamin Van Parys Giulio Bevilacqua

Robot-assisted kidney transplantation (RAKT) has recently been introduced to reduce the morbidity of open kidney transplantation (KT). Robot-assisted surgery has been able to overcome many of the limitations of classical laparoscopy, certainly in complex and technically demanding procedures, such as vascular and ureteral anastomosis. Since the first RAKT in 2010, this technique has been standardized and evaluated in highly experienced robot and KT centers around the world. In Europe, the European Association of Urology Robotic Urology Section (ERUS) created an RAKT working group in 2016 in order to prospectively follow the outcomes of RAKT. When performed by surgeons with both robotic and KT experience, RAKT has been proven to be safe and reproducible in selected cases and yield excellent graft function with a low complication rate. Multiple institutions have now adopted RAKT, and its use will likely increase in the near future. However, structured training and proctoring will be mandatory for those embarking on RAKT in order to help them negotiate the learning curve and avoid technical mistakes. This chapter will describe RAKT from living and deceased donors and its application in kidney autotransplantation (KAT).

10.5772/intechopen.90276

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Cystoscopy-Guided Robot-Assisted Partial Cystectomy for the Treatment of an Inflammatory Myofibroblastic Tumor: A Video Case Report

Videourology (2021)

Dries Develtere Ralf Veys Camille Berquin Benjamin Van Parys Elisabeth Pauwels

An inflammatory myofibroblastic tumor (IMT) can arise anywhere in the body. IMT is a spindle-cell neoplasm not prone to metastasize although it has an important potential of local expansion. We report an IMT in a 55-year-old male who was initially treated with a transurethral resection of the bladder tumor (TURBT) and subsequently underwent a robot-assisted partial cystectomy. Step 1 of the procedure was installation of the patient. Since we performed the procedure with the Da Vinci Xi system®, we were able to install the patient in supine position followed by side docking. Step 2 was marking the tumor in the peritoneum of the bladder dome. During step 3, we developed Retzius' space. Step 4 consisted of using simultaneous cystoscopy, performed by the bedside table assistant, guiding the dissection aiming for complete excision of the tumor with a negative surgical margin of at least 2 cm macroscopically. This was facilitated using the TilePro™ feature that allows simultaneous observation of cystoscopy and laparoscopy image inside the console. Since in this case the tumor originated from the bladder dome, step 5 consisted of excising the urachus en bloc with the tumor. During step 6, we placed the tumor in an Endo Bag. Step 7 consisted of closure of the bladder in two layers using V-lock 3-0. To finish of the procedure, a leakage test was performed, followed by extraction of the tumor in the Endo Bag. No postoperative problems were reported, and the patient was discharged the second day after surgery. Transurethral catheter was removed in the outpatient clinic on day 7, after cystography ensured no leakage was present. Definitive pathologic report confirmed the presence of a spindle-cell proliferation with eosinophilic cytoplasm. A follow-up cystoscopy 5 months after surgery showed no recurrence. Bladder capacity was excellent without any change in micturition pattern. Future follow-up will consist of yearly cystoscopy. When complete resection of IMT with TURBT is not feasible, a robot-assisted partial cystectomy with simultaneous cystoscopy is a minimally invasive option facilitating complete resection with negative surgical margins and maximal preservation of bladder function. No competing financial interests exist. Runtime of video: 1 min 58 secs

Bladder tumor

10.1089/vid.2020.0137

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Citations (0)

Intracorporeal versus extracorporeal robot-assisted kidney auto transplantation: Experience of the ERUS RAKT working group

European Urology Open Science (2021)

Pietro Diana Alberto Breda Angelo Territo Andrea Gallioli Alberto Piana

Extracorporeal

10.1016/s2666-1683(21)02272-2

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Citations (2)

Robot-assisted radical prostatectomy in patients with previous HoLEP: Preliminary results from a single institution study