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News Asia Pacific

Pelvic bed lined with ice slush to achieve pelvic-bed cooling before introduction of the graft kidney (left); additional ice slush delivered onto the graft kidney immediately after its introduction to achieve uniform cooling (right). (Photo: Medanta hospital)
Feb 6, 2014 | News Asia Pacific

“Icy” technique improves robotic kidney transplants

by Surgical Tribune

GURGAON, India/DETROIT, USA: As part of a study, surgeons at Medanta hospital in India and Henry Ford Hospital in Detroit have successfully transplanted kidneys into 50 recipients using an innovative robot-assisted procedure in which the organ is cooled with sterile ice during the operation.

“Minimally invasive surgery reduces post-operative pain and minimises complications in comparison to conventional surgery,” according to Dr Mani Menon, Director of Henry Ford’s Vattikuti Urology Institute and co-author of the study. “The benefits of minimally invasive surgery in removing donor kidneys has been well established in earlier studies, but the use of robot-assisted surgery in transplanting those kidneys is comparatively a frontier,” Menon added.

The Henry Ford researchers and their counterparts in Gurgaon reasoned that since minimally invasive robotic surgery has proved to be of great benefit to healthy kidney donors, it might also be used in the case of ill and weakened transplant recipients, who are at greater risk of complications. However, they noted British research from 1971 that demonstrated that kidney function was partially impaired in recipients if blood flow was interrupted for longer than 30 minutes during transplantation. Thus, they decided to chill both the donor kidney and the transplant site with sterile ice slush in the hope of increasing the amount of time in which they could safely learn and perfect the robot-assisted surgery.

“To our knowledge, ours is the first study to use renal cooling during robotic kidney transplant,” Menon said. “It had already proved useful during minimally invasive prostate surgeries.”

After three years of planning and simulated surgeries at Henry Ford, 50 transplant patients who had volunteered for the minimally invasive procedure underwent consecutive robotic kidney transplants at Medanta between January and October 2013.

Medanta has performed 54 operations and the Institute of Kidney Diseases and Research Center at Ahmedabad in India has done 56 operations, a total of 110 transplants in one year. In each case, surgeons filled the kidney cavity with ice slush through a specially designed port in the patient’s abdomen before transplanting the donor kidney, which was also chilled with ice slush held in place by gauze wrapping. Blood vessels were attached to the transplanted kidney using suturing techniques refined in other types of minimally invasive procedures. Immediately after the transplant, all of the grafted kidneys functioned normally and patient levels of creatinine—used to measure kidney function—were well within the normal range. None of the patients developed blood or urine leaks, infections or other complications from their surgical wounds. None required dialysis after surgery. During follow-up examinations six months after surgery, nearly all of the first 25 patients who underwent the procedure developed no complications, although two required exploratory surgery and one died of acute congestive heart failure. Menon attributed the success of the study in part to the seamless collaboration between surgeons experienced in conventional open-surgery kidney transplants and surgeons skilled in using robotic techniques.

By the time they began the study, the teams from Henry Ford and Medanta hospitals had performed more than 10,000 robotic procedures and 2,500 conventional kidney transplants. “The individual surgeons involved had built an atmosphere of trust and mutual respect over 30 years of collaborative work,” Menon said. “While this benefit can’t be precisely measured, it clearly contributed to the success of this endeavor.” The researchers noted that further studies will be needed before robotic kidney transplant is widely accepted as a viable alternative to conventional transplantation.

The study, titled “Robotic kidney transplantation with regional hypothermia: A step-by-step description of the Vattikuti Urology Institute–Medanta technique”, was published online ahead of print in European Urology, the journal of the European Association of Urology.

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