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Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative?
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
V92
Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative? Eur Urol Suppl 2017; 16(3);e2158
Pradere B.1, Lesourd M.2, Beauval J.B.2, Roumiguié M.2, Binhazzaa M.2, Rischmann P.2, Soulié M.2, Gamé X.2, Sallusto F.2, Doumerc N.2 1
Chu Toulouse, Dept. of Urology, Toulouse, France, 2CHU Toulouse, Dept. of Urology, Toulouse, France INTRODUCTION & OBJECTIVES: Nowadays, management of obese patients with end-stage renal disease (ESRD) is complicated. Due to intraoperative and postoperative complications increased in this population, most obese patients are recused for renal transplantation. The objective of this video is to show the technic and the feasibility of robot-assisted renal transplantation (RART) in obese patients. MATERIAL & METHODS: In an academic centre specialised in robot-assisted surgery, a specific technic of RART for obese patients was developed. We used the four arms Da Vinci© Si HD robot (Intuitive surgical) with three 8mm robotic ports for robot’s instruments, one 12-mm port for the robotic scope and 2 ports for the co-surgeon (10 and 5 mm). the patient is positioned supine with legs on leg rests. We performed a transperitoneal approach with introduction of the graft through a hand-access device (Alexis©, Applied medical) positioned 1cm above the umbilicus (Figure 1). The vascular anastomosis was preferentially done on left external iliac vessels with an end-to side suture in a continuous fashion. RESULTS: We present the case of a 56 years-old women, under anticoagulant, with chronic dialysis for ESRD due to sarcoidosis. Despite a strict weight-loss program, her BMI was 37 Kg/m2, which was the cause of two consecutive contraindications to open transplantation. Operative time was 155 min (5 min for docking, 20 min for vessels dissection, 18 min venous clamping, 22 min for arterial clamping and 15 min for urinary anastomosis). There was no postoperative complication. Doppler performed at day one and seven were normal. Morphine drugs were stopped at day 1 and other analgesics were stopped at day 3. CONCLUSIONS: Robot-assisted renal transplantation is a new surgical technic in development. This surgical approach seems particularly useful for obese patients for who an open approach is contraindicated or difficult, with high risk of postoperative complications.
Eur Urol Suppl 2017; 16(3);e2158
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
V92
Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative? Eur Urol Suppl 2017; 16(3);e2159
Eur Urol Suppl 2017; 16(3);e2159
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
V92
Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative? Eur Urol Suppl 2017; 16(3);e2160
Eur Urol Suppl 2017; 16(3);e2160 Powered by TCPDF (www.tcpdf.org)
V92
Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative? Eur Urol Suppl 2017; 16(3);e2158
Pradere B.1, Lesourd M.2, Beauval J.B.2, Roumiguié M.2, Binhazzaa M.2, Rischmann P.2, Soulié M.2, Gamé X.2, Sallusto F.2, Doumerc N.2 1
Chu Toulouse, Dept. of Urology, Toulouse, France, 2CHU Toulouse, Dept. of Urology, Toulouse, France INTRODUCTION & OBJECTIVES: Nowadays, management of obese patients with end-stage renal disease (ESRD) is complicated. Due to intraoperative and postoperative complications increased in this population, most obese patients are recused for renal transplantation. The objective of this video is to show the technic and the feasibility of robot-assisted renal transplantation (RART) in obese patients. MATERIAL & METHODS: In an academic centre specialised in robot-assisted surgery, a specific technic of RART for obese patients was developed. We used the four arms Da Vinci© Si HD robot (Intuitive surgical) with three 8mm robotic ports for robot’s instruments, one 12-mm port for the robotic scope and 2 ports for the co-surgeon (10 and 5 mm). the patient is positioned supine with legs on leg rests. We performed a transperitoneal approach with introduction of the graft through a hand-access device (Alexis©, Applied medical) positioned 1cm above the umbilicus (Figure 1). The vascular anastomosis was preferentially done on left external iliac vessels with an end-to side suture in a continuous fashion. RESULTS: We present the case of a 56 years-old women, under anticoagulant, with chronic dialysis for ESRD due to sarcoidosis. Despite a strict weight-loss program, her BMI was 37 Kg/m2, which was the cause of two consecutive contraindications to open transplantation. Operative time was 155 min (5 min for docking, 20 min for vessels dissection, 18 min venous clamping, 22 min for arterial clamping and 15 min for urinary anastomosis). There was no postoperative complication. Doppler performed at day one and seven were normal. Morphine drugs were stopped at day 1 and other analgesics were stopped at day 3. CONCLUSIONS: Robot-assisted renal transplantation is a new surgical technic in development. This surgical approach seems particularly useful for obese patients for who an open approach is contraindicated or difficult, with high risk of postoperative complications.
Eur Urol Suppl 2017; 16(3);e2158
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
V92
Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative? Eur Urol Suppl 2017; 16(3);e2159
Eur Urol Suppl 2017; 16(3);e2159
32nd Annual EAU Congress, 24-28 March 2017, London, United Kingdom
V92
Renal transplantation in obese recipients: Could robot-assisted surgery become a real alternative? Eur Urol Suppl 2017; 16(3);e2160
Eur Urol Suppl 2017; 16(3);e2160 Powered by TCPDF (www.tcpdf.org)