Robotic renal autotransplantation

Objective: Robotic renal autotransplantation offers a minimally invasive approach for complex urological cases involving renal vascular anomalies or long-segment ureteral strictures. This case report presents a robotic technique combining donor nephrectomy and transplantation, with reduced morbidity and shorter recovery. Methods: A 32-year-old female with right ureteral avulsion following a complicated C-section underwent robotic renal autotransplantation. The procedure was performed using the Da Vinci® Xi robotic surgical system with a 6-cm periumbilical incision and four robotic ports. The kidney was removed through a GelPOINT device, flushed with HTK solution, and prepared for transplantation. Vascular anastomoses were performed using GORE-TEX sutures, and ureteral reimplantation was completed with a Monocryl suture. Results: The procedure was successful with an estimated blood loss of 300 ml. Warm ischemia time was 5 min, and total ischemia time was 60 min. External iliac vein and artery clamp times were 27 and 30 min, respectively. The patient recovered well with no complications up to one year post-surgery. A follow-up MAG3 scan showed no evidence of obstruction and preserved renal function. Conclusion: Robotic renal autotransplantation is a viable minimally invasive option for select patients with complex urological issues. This technique combines the benefits of robotic surgery with the established principles of renal transplantation, offering potential advantages in terms of recovery and outcomes for suitable candidates.