New 'Icy' technique improves robotic kidney transplants

Surgeons in India and US have successfully transplanted kidneys into 50 patients using an innovative robot-assisted procedure.
A collaboration of surgeons at Medanta Hospital in India and Michigan-based Henry Ford Hospital, conducted the procedure in which the organ is cooled with sterile ice during the operation.
"The benefits of minimally invasive surgery in removing donor kidneys has been well established in earlier studies, but the use of robot-assisted surgery in transplanting those kidneys is comparatively a frontier," said Mani Menon, chair of Henry Ford's Vattikuti Urology Institute and co-author of the study.
The Henry Ford researchers and their counterparts in Gurgaon reasoned that since minimally invasive robotic surgery has proven to be a great benefit to healthy kidney donors, it might also be a boon to the ill and weakened transplant recipients who are at greater risk of complications.

Researchers knew that kidney function was partially impaired in recipients if blood flow was interrupted for longer than 30 minutes during transplant.
So they decided to chill both the donor kidney and the transplant site with sterile ice slush in hopes of increasing the amount of time in which they could safely learn and perfect the robot-assisted surgery.

"To our knowledge, ours is the first study to use renal cooling during robotic kidney transplant. It had already proved useful during minimally invasive prostate surgeries," Menon said.
After three years of planning and simulated surgeries at Henry Ford, 50 consecutive transplant patients who had volunteered for the minimally invasive procedure underwent robotic kidney transplant at Medanta Hospital between January and October 2013.

In all, Medanta Hospital has performed 54 operations and International Kidney and Renal Diseases at Ahmedabad has done 56 operations, for a total of 110 transplants in one year.
In each case, surgeons filled the kidney cavity with ice slush through a specially designed port in the patient's abdomen before transplanting the donor kidney, which was also chilled with ice slurry held in place by gauze wrapping.
Blood vessels were attached to the transplanted kidney using suturing techniques refined in other types of minimally invasive procedures.
Immediately after transplant, all of the grafted kidneys functioned normally and patient levels of creatinine - used to measure kidney function - were well within normal range.

None of the patients developed blood or urine leaks, infections or other complications from their surgical wounds. None required dialysis after surgery.
In a follow-up exam six months after surgery, nearly all of the first 25 patients who underwent the procedure developed no complications, although two required exploratory surgery and one died of acute congestive heart failure.
The study is published in journal European Urology.