Robotic-Assisted Renal Autotransplantation

In 1962, Hardy performed the first kidney autotransplantation (KAT) (Hardy, JAMA J Am Med Assoc, 1963). Since then, KAT has been considered as the ultimate way to salvage kidneys with complex renovascular, ureteral, or malignant pathologies. Kidney autotransplantation (KAT) consists in the removal of the native kidney from its original place, repair it, and finally transplant it in another location of the patient’s body. KAT is an attractive procedure because it theoretically addresses the underlying pathology while eliminating the problems associated with allogeneic transplantation. Today, the gold standard for kidney auto-transplantation (KAT) is the combination between a laparoscopic nephrectomy followed by an open kidney transplantation (Fabrizio et al. Urology, 2000; Tran et al. J Urol, 2015). However, the push to perform more precise procedures brought robot-assisted (RA) surgery to find indications in kidney transplantation (KT) (Breda et al. World J Urol, 2016; Musquera et al. BJU Int, 2021), a technique that is expanding in several high volume institutions. The largest European multi-institutional prospective study on RAKT confirmed the feasibility of the technique, which merges the advantages of minimally invasive surgery (smaller incisions, less pain, faster recovery time) with functional results comparable to open KT5. Subsequently, robot-assisted kidney auto-transplantation (RAKAT) has been introduced for patients with complex renal vascular anomalies or extended ureteral strictures unsuitable for an in situ reconstruction (Doumerc et al. Int J Surg Case Rep, 2018; Gordon J Urol, 2014; Araki et al. Acta Med Okayama, 2017; Decaestecker et al. Eur Urol Focus, 2018; Breda et al. Eur Urol. 81(2), 2022). In this chapter we will explore the indications and the surgical outcomes of RAKAT and the step-by-step procedure for intracorporeal and extracorporeal RAKAT will be provided.