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842 Robotic kidney transplantation with regional hypothermia: Results from a prospective two-arm non-randomized controlled trial (Ideal Phase 2b)
Title
842
Robotic kidney transplantation with regional hypothermia: Results from a prospective two-arm non-randomized controlled trial (Ideal Phase 2b) Eur Urol Suppl 2015;14/2;e842
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Sood A. 1 , Ghosh P. 2 , Jeong W.1 , Bhandari M. 1 , Ahlawat R.2 , Menon M. 1 1 Henry
Ford Health System, Vattikuti Urology Institute, Detroit, United States of America, 2 Medanta -The Medicity, Vattikuti Institute of
Robotic Surgery, Kidney and Urology Institute, Gurgaon, India INTRODUCTION & OBJECTIVES: Minimally invasive approaches to kidney transplantation are up-coming. We recently developed and described a novel technique of robotic KT (RKT) using intra corporeal graft cooling. Here, we assess the comparative effectiveness of RKT and open KT (OKT) by evaluating peri- and postoperative outcomes. MATERIAL & METHODS: From Jan-Dec 2013, a total of 247 patients with end stage renal disease underwent KT at a tertiary referral center of which 225 patients who met the selection criteria (live donor, first transplant, single organ transplant and low-intermediate immunologic risk) were enrolled into this prospective two-arm non-randomized controlled trial (IDEAL Phase-2b). Primary outcome was post transplant graft function. Secondary outcomes included surgical and immunologic complications, and perioperative parameters. All patients had a minimum follow up of 6 months. RESULTS: Fifty and 175 patients underwent RKT and OKT, respectively. The baseline characteristics of the two groups were comparable. Mean serum creatinine at discharge was 1.2 and 1.3 mg/dl in RKT and OKT patients respectively (p=0.71). Post-operative pain and analgesic requirements were significantly less in patients undergoing RKT (p=0.01). None of the RKT patients developed any wound complications and none had delayed graft function. Eleven patients in the RKT group required a biopsy and 7 developed acute rejection. One RKT patient and 4 (2.2%) of OKT needed post-transplant dialysis. No lymphocele was detected on protocol non-contrast CT done at 3 months in the RKT group (0% vs. 23.8% in OKT; p=0.05). One graft was lost in the OKT group. One patient death in RKT (1.5 months post transplant, cardiac failure) and 2 in OKT group were noted, respectively. CONCLUSIONS: RKT with regional hypothermia is safe and easily reproducible. Early outcomes are equivalent to OKT; with trends towards lower complications, quicker graft function recovery and shorter patient convalescence.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/842.html[19/02/2015 08:21:49]
842
Robotic kidney transplantation with regional hypothermia: Results from a prospective two-arm non-randomized controlled trial (Ideal Phase 2b) Eur Urol Suppl 2015;14/2;e842
Print! Print!
Sood A. 1 , Ghosh P. 2 , Jeong W.1 , Bhandari M. 1 , Ahlawat R.2 , Menon M. 1 1 Henry
Ford Health System, Vattikuti Urology Institute, Detroit, United States of America, 2 Medanta -The Medicity, Vattikuti Institute of
Robotic Surgery, Kidney and Urology Institute, Gurgaon, India INTRODUCTION & OBJECTIVES: Minimally invasive approaches to kidney transplantation are up-coming. We recently developed and described a novel technique of robotic KT (RKT) using intra corporeal graft cooling. Here, we assess the comparative effectiveness of RKT and open KT (OKT) by evaluating peri- and postoperative outcomes. MATERIAL & METHODS: From Jan-Dec 2013, a total of 247 patients with end stage renal disease underwent KT at a tertiary referral center of which 225 patients who met the selection criteria (live donor, first transplant, single organ transplant and low-intermediate immunologic risk) were enrolled into this prospective two-arm non-randomized controlled trial (IDEAL Phase-2b). Primary outcome was post transplant graft function. Secondary outcomes included surgical and immunologic complications, and perioperative parameters. All patients had a minimum follow up of 6 months. RESULTS: Fifty and 175 patients underwent RKT and OKT, respectively. The baseline characteristics of the two groups were comparable. Mean serum creatinine at discharge was 1.2 and 1.3 mg/dl in RKT and OKT patients respectively (p=0.71). Post-operative pain and analgesic requirements were significantly less in patients undergoing RKT (p=0.01). None of the RKT patients developed any wound complications and none had delayed graft function. Eleven patients in the RKT group required a biopsy and 7 developed acute rejection. One RKT patient and 4 (2.2%) of OKT needed post-transplant dialysis. No lymphocele was detected on protocol non-contrast CT done at 3 months in the RKT group (0% vs. 23.8% in OKT; p=0.05). One graft was lost in the OKT group. One patient death in RKT (1.5 months post transplant, cardiac failure) and 2 in OKT group were noted, respectively. CONCLUSIONS: RKT with regional hypothermia is safe and easily reproducible. Early outcomes are equivalent to OKT; with trends towards lower complications, quicker graft function recovery and shorter patient convalescence.
file:///S|/IM/EURSUP/2015%20EAU%20Abstracts/content/data/842.html[19/02/2015 08:21:49]