Introduction: Bladder transplantation has not yet been successfully performed. Technical challenges include complicated deep pelvic vascular anatomy, limited visualization, and procedural complexity. In preparation for a first-in-human clinical trial of bladder transplantation (NCT05462561), we performed a robotic vascularized composite bladder allograft (VCBA) autotransplantation in a brain-dead heart-beating research donor. Methods: An appropriate research donor was identified by our local organ procurement organization. VCBA autotransplantation was performed, including VCBA dissection, extracorporeal back-tabling, vascular reanastomoses, and vesicourethral anastomosis. A robotic approach was necessary to optimize visualization in the deep pelvis and maximally preserve allograft perfusion. The primary objective was to develop the stepwise procedure and gauge its technical success, defined by autograft perfusion by direct visual inspection and indigo-cyanine green (ICG) fluorescence. Secondary objectives included intraoperative parameters (operative times, warm ischemia time, and EBL). IRB (HS-21-00162) approval was obtained. Results: Technical success, defined by adequate autograft perfusion after vascular anastomosis, was achieved. In the brain-dead heart beating donor, the technical maneuvers were well tolerated, with intra-operative hemodynamic stability (Table 1). Operative time was 670 min. Visual inspection revealed a pink, healthy bladder and patent vascular anastomoses, with diffuse ICG uptake. Conclusions: This is the first documented case of robotic bladder autotransplantation, performed in a brain-dead heart-beating research donor as a necessary preclinical step towards a first-in-human trial of bladder transplantation (NCT05462561). Technical feasibility was demonstrated, and vascular viability was confirmed by ICG uptake. The robotic approach was necessary for fine vascular dissection in the deep pelvis. SOURCE OF Funding: This study has been supported by a clinical research grant from the OneLegacy Foundation.
