Robotic assisted En-Bloc dual kidney transplant

Robotic assisted kidney transplant for the recipient is being performed at several centres around the world as a minimally invasive alternative to the traditional open transplant surgery. Several studies have documented better perioperative recovery. Here we present a case of enbloc dual kidney transplant performed robotically, probably first such report to the best of our knowledge. The deceased donor in this case was a 13 month old child weighing 8 kg. Bilateral kidneys were harvested enbloc along with aorta and Inferior Vena Cava (IVC) after insitu perfusion. Careful bench dissection was performed and top ends of the aorta and IVC were closed and lower ends were left open for the anastomosis to external iliac vessels. The enbloc kidneys were inserted into the recipient through a 6cm pfannenstiel incision. The lower ends of aorta and IVC were anastomosed to the external iliac vessels with 6-0 PTFE suture in end-to-side fashion. Enbloc kidneys were placed in the extra peritoneal space and peritoneum wrapped over them. Bilateral ureters were joined together before extra-vesical reimplantation to the bladder. Total operative time was 235 min and ischemia time was 85 min. Arterial and venous anastomosis times were 19 and 21min respectively. Brisk urine output was noted intra-operatively and doppler showed normal indices in both kidneys. Creatinine at discharge was 1.5 mg/dl. Robotic enbloc kidney transplantation is feasible and safe at an experienced robotic center.