Bench Surgery with Robot-assisted Kidney Autotransplantation for Complex Kidney Tumors: Technique and Outcomes from a Single Center

Abstract

Background and objective

Bench surgery (BenS) with kidney autotransplantation serves as an alternative to nephron-sparing surgery (NSS) for patients harboring high-complexity renal tumors that are ineligible for in situ partial nephrectomy (PN). However, the experience of BenS with robot-assisted kidney autotransplantation (RAKAT) has been scarce in such cases. Here, we describe the operative techniques, and functional and oncological outcomes of BenS with RAKAT.

Methods

We reviewed prospectively followed 12 patients with complex solitary or bilateral kidney tumors who underwent robot-assisted nephrectomy (RAN) with BenS and RAKAT at our institution from January 2018 to May 2021 and all surgical procedures were performed by the same surgical team. The surgical, functional, and oncological outcomes were assessed.

Key findings and limitations

All surgical margins were negative. The median operative time was 480 min, and the median console times of RAN and RAKAT were 100 and 161 min, respectively. The median warm ischemia, cold ischemia, and rewarming times were 3, 178, and 55 min, respectively. The median estimated blood loss was 100 ml. Three patients presented grade IV complications, including one case of septic shock resolved with antibiotics and supportive care, and two cases with delayed graft function resolved with temporary dialysis. The median percentage of ipsilateral estimated glomerular filtration rate preserved at 3 mo was 51.1%. Two patients had progressing disease at a median follow-up of 70 mo.

Conclusions and clinical implications

BenS with RAKAT is an alternative strategy for the treatment of high-complexity renal tumors that are unsuitable for in situ PN. Larger prospective studies with longer follow-up are required to further assess the findings.

Patient summary

We evaluated the outcomes of bench surgery (BenS) with robot-assisted kidney autotransplantation (RAKAT), in which the diseased kidney is removed, undergo partial nephrectomy (PN) extracorporeally, and is transplanted back robotically. We found that for patients with complex solitary or bilateral kidney tumors who are not eligible for in situ PN, BenS with RAKAT is a safe and feasible alternative of nephron-sparing surgery with acceptable functional and oncological outcomes.