Abstract:

Objective: To review and summarize the experience of robot-assisted laparoscopic transplant nephrectomy, share the surgical steps and technical key points, and provide a reference for clinical practice. Methods: A retrospective analysis was conducted on the perioperative data of 5 patients who underwent robot-assisted laparoscopic donor nephrectomy at Peking University Third Hospital from August 2023 to December 2024. The surgical steps and key points were summarized. The continuous variables were described by medians(ranges). Results: A total of 5 patients were included in the analysis, of whom 2 were male and 3 were female. The median age of the patients was 37 (31-68) years. The median time from kidney transplantation to donor nephrectomy was 10 (3-22) years. The indications for donor nephrectomy included recurrent hematuria, abdominal pain, malignant tumor of the transplanted kidney, and recurrent infection with hydronephrosis of the transplanted kidney. The excised transplanted kidneys from all the 5 patients had a single renal artery and a single renal vein. The median operation time was 212 (145-351) min, the median blood loss was 300 (20-500) mL, and the median post-operative hospital stay was 7 (4-25) days. Only 1 patient experienced intraoperative complications, who experienced an external iliac artery injury during the operation and underwent suture repair. No patient died during the perioperative period. Postoperative pathological results showed that 3 patients had end-stage non-functional kidneys, 1 patient had BK virus-associated urothelial carcinoma, and 1 patient had chronic pyelonephritis with renal parenchymal atrophy. Conclusion: Robot-assisted laparoscopic transplant nephrectomy as a new surgical approach is feasible and safe. Compared with traditional open transplant nephrectomy, its advantage lies in the ability to directly observe and prioritize the management of the renal pedicle of the transplanted kidney, while completely freeing and removing the transplanted kidney outside the renal capsule. With the continuous accumulation of experience, this surgical technique is expected to become a powerful alternative to traditional open transplant nephrectomy.

Key words: Kidney transplantation, Transplants, Nephrectomy, Robotic surgical procedures