Robotic Assisted Laparoscopic Kidney Transplantation in Children-An Initial Experience.

摘要

Introduction: To place adult size kidney for transplantation in children a large incision is required in iliac fossa. Minimally invasive laparoscopic and robotic reconstructive surgery in children are well accepted by parents. Here we present our initial experience of robotic assisted laparoscopic kidney transplantation (RAKT) in five children. Material and method: With permission from IRB five children underwent RAKT in year 2013. Concomitant seminal vesicle cyst excision and nephrectomy was carried out in two children. All but one kidney were procured from living donor. Operative procedure: 300 Trendelenburg and Lithotomy position was given and robot docked between two legs. Six ports including three robotic ports, one for camera, one for suction and irrigation and one for assistant are placed. Common iliac vessels in two cases and external iliac vessels in three cases were dissected for anastomosis. A 6 cm pfannenstiel incision was made to introduce kidney and ice slush. Wound was closed and robot was re-docked. Vascular anastomosis was carried out using Gore Tex CV 6 suture. Ureteroneocystostomy was performed by vicryl 4/0 suture without using stent. Results: Mean operative time for RAKT was 280 min (210-310 min). cold ischemia time was 106.5 minutes in living donor cases and 14 hours in deceased donor case. Blood loss was 97.5 ml (50-120 ml). Anastomosis time and total re-warming time were 47.8 mn. (36-55 min)and 68 (58-84 min), respectively. One patient had spontaneous rupture of graft on 3rd post operative day requiring emergency exploration. She had delayed graft function. In 4 children, mean eGFR was 116 (90-139 ml/m2) on 7th post operative day. Conclusion: RAKT in children is technically feasible and safe. Concomitant ablative surgery in pelvic cavity can be accomplished with help of robot at the time of transplantation.