Chairman Max Superspeciality Hospital, Saket , New Delhi
Introduction: Robotic assisted kidney transplant (RAKT) is a feasible treatment option for patients with end stage renal disease. Despite the advantages of enhanced dexterity and wristed instruments, the problem of increased rewarm ischemia and longer vascular anastomosis time persists especially with multiple vessel renal allografts (MVRA). Our objective was to demonstrate technical feasibility of utilising the internal iliac artery autograft (IIAA) in RAKT to reduce rewarm ischemia times in a triple vessel renal allograft. Methods: We present an innovative technique to utilize the internal iliac artery autograft in RAKT to manage MVRA which has never been reported previously. The donor had three vessels on left side and one single vessel on right side but the left kidney had lower glomerular filtration rate and smaller size in comparison to the right, so the left kidney was harvested laparoscopically. The technique is divided into three distinct steps. Step 1 is the retrieval of the IIAA, preparing the external iliac vessels for future anastomosis and raising a peritoneal flap for the transplant kidney. Step 2 involves bench dissection and ex-vivo vascular reconstruction to anastomose MVRA with IIAA. The final step is to anastomose this autograft-allograft complex with the external iliac vessels. Results: We were able to perform a single in-vivo arterial anastomosis for a triple vessel renal allograft thereby reducing warm ischemia times. It took only 17 minutes to perform a single arterial anastomosis and if we would’ve done three anastomoses, the total rewarm ischemia time would have exceeded 60 minutes. Thus a single anastomosis enabled us to significantly reduce the rewarm ischemia time. Conclusions: Our technique eliminates the need for more than one arterial anastomosis, reduces the rewarm ischemia time and represents an innovative method to manage grafts with multiple vessels during RAKT SOURCE OF Funding: None
