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The Evolution of Kidney Transplantation Surgery Into the Robotic Era and Its Prospects for Obese Recipients

Hameed, Ahmer M., MS1,2,3; Yao, Jinna, MS1; Allen, Richard D.M1,2,3; Hawthorne, Wayne J., PhD1,2,3; Pleass, Henry C., MD1,2,3; Lau, Howard1,4

doi: 10.1097/TP.0000000000002328
Reviews

Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20th century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means. The different techniques, indications, advantages, disadvantages, and future directions of this approach will be explored in detail. Robot-assisted kidney transplantation may become the preferred means of transplanting morbidly obese recipients, although its availability to such recipients remains extremely limited and strategies targeting weight loss pretransplantation should never be abandoned in favor of a “RAKT-first” approach.

This review describes the advent of robotic-assisted kidney transplantation, including indications, the different available techniques, advantages, disadvantages, and future directions, with particular emphasis on its potential to facilitate transplantation of those deemed previously too obese to transplant using standard surgical techniques.

1 Department of Surgery, Westmead Hospital, Sydney, Australia.

2 Centre for Transplant and Renal Research, Westmead Institute for Medical Research, Sydney, Australia.

3 Discipline of Surgery, Sydney Medical School, University of Sydney, Sydney, Australia.

4 Discipline of Surgery, School of Medicine, Western Sydney University, Sydney, Australia.

Received 16 January 2018. Revision received 1 June 2018.

Accepted 8 June 2018.

The authors declare no funding or conflicts of interest.

A.M.H. participated in article content design, writing, and revision. J.Y. produced the supplementary digital content and participated in article writing, and revision. R.A. participated in article content writing, and revision. W.H. participated in article content writing, and revision. H.P. participated in article content design/outline, writing, and revision. H.L. participated in article content design/outline, writing, and revision.

Correspondence: Howard Lau, FRACS, Department of Surgery, Westmead Hospital, Cnr Darcy Road and Hawkesbury Road, Westmead, NSW 2145, Australia. (drhlau@gmail.com).

Supplemental digital content (SDC) is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.transplantjournal.com).

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