Vaginal Insertion of Kidney and Robotic Assisted Laparoscopic Kidney Transplantation: The First World Experience.

Abstract

Introduction: Following laparoscopic or robotic assisted living donor nephrectomy kidney retrieval through vagina are reported. Here we present our initial experience of insertion of kidney through vagina and robotic assisted laparoscopic kidney transplantation (RKT). Material and methods: Permission of IRB was obtained. Major inclusion criteria were at least one normal vaginal delivery and good capacity of vagina on examination. Exclusion criteria were active vaginal infection or atrophic vagina. Antibiotic prophylaxis was used. Total 3 transplants carried out. Recipient surgery: In 30 degree Trendelenberg and Lithotomy position six ports were placed; one camera port, three robotic ports, one assistant port and one port for suction and irrigation. External iliac vessels were dissected. Robot was undocked. Gynecologist placed an incision in posterior fornix of vagina and kidney was inserted into abdomen. Wound of posterior fornix was closed and vagina packed. Robot was re-docked and kidney brought close to previously dissected external iliac vessels. Vascular anastomosis was carried out by Gore Tex CV6 suture. Ureteric reimplantation was performed using 4/0 vicryl without stent. Results: There was no injury to kidney parenchyma, no delayed graft function and no infection. Mean anastomosis time, rewarming time and blood loss were 51 min., 72 min., 67.5 ml respectively. Six months graft and patient survival is 100%. Conclusion: Vaginal insertion of kidney and RKT is feasible and safe. Larger studies are required for confirmation of these findings.