Robotic kidney autotransplantation with extracorporeal arterial and venous reconstruction for complex ureteral stricture: a technical note

Introduction:  Kidney autotransplantation is an organ-preserving option for selected patients with complex ureteral or renovascular pathology not amenable to in situ reconstruction. Conventional open autotransplantation, however, is associated with substantial morbidity. Robotic kidney autotransplantation (RKAT) has emerged as a minimally invasive alternative, but detailed technical reports of complex cases requiring vascular reconstruction remain limited.

Technical Description:  We report the technique of RKAT in a 32-year-old woman with a radiation-induced high-grade ureteral stricture refractory to endoscopic management and not amenable to standard ureteral reconstruction. The procedure consisted of robotic nephrectomy, extracorporeal back-table reconstruction of dual renal arteries using a fish-mouth technique, extension of the short right renal vein with a bovine pericardial conduit, robotic implantation to the right external iliac vessels, and neocystoureterostomy. A detailed operative description is accompanied by a narrated surgical video.

Initial Experience:  Console times for nephrectomy and implantation were 99 and 228 minutes, respectively. First warm ischemia time was 3 minutes, cold ischemia time was 3 hours, and second warm ischemia time was 36 minutes. The postoperative course was uncomplicated, and the patient was discharged on postoperative day 3 with preserved renal function and satisfactory graft perfusion.

Conclusion:  Robotic kidney autotransplantation with extracorporeal vascular reconstruction is a feasible minimally invasive option for carefully selected patients with complex ureteral pathology. This report provides technical insight into the operative strategy and reconstructive steps involved in RKAT.

Keywords:
Robotics; Kidney Autotransplantation; Ureteral Stricture; Surgical Technique; Transplantation