Patient Details
Age/Sex: 33-year-old male
Diagnosis: End-Stage Renal Disease (IgA Nephropathy) on Maintenance Hemodialysis
Comorbidities: Hypertension
Overview
The patient, a known case of hypertension and end-stage renal disease secondary to IgA nephropathy, was on maintenance hemodialysis via a left BC AV fistula. He presented for renal transplantation.
- Recipient blood group: O negative
- Donor: Mother, blood group O positive, known hypothyroidism on treatment
- Donor kidney: Left kidney with single renal artery, two renal veins, and two ureters
- HLA match: 3/6 with negative T- and B-cell crossmatching
Why Robotic Surgery Was Chosen
Robotic-assisted transplant was selected to achieve less pain, early mobilization, better cosmetic outcomes, and shorter hospital stay.
Surgery Performed: Robotic-Assisted Kidney Transplant
Key Steps and Robotic Advantages:
- Enhanced precision and dexterity for vascular and ureteral anastomoses
- 3D visualization of the operative field
- Minimally invasive approach: Four 8 mm robotic ports and one 12 mm assistant port, with a 5–6 cm Pfannenstiel incision
- Operative time: 5 hours 25 minutes (bed prepared in 50 min)
- Arterial anastomosis: 33 minutes
- Venous anastomosis: 30 minutes
- Ureteral anastomosis: 32 minutes
- Warm ischemia time: 6 minutes
- Cold ischemia time: 1 hour 43 minutes
- Estimated blood loss: 100 mL
Postoperative Outcomes
- Recovery metrics:
- Immediate post-op diuresis; serum creatinine fell from 4.78 mg/dL (POD 1) to 2.29 mg/dL (POD 3)
- On POD 4, urine output dropped and creatinine rose; treated with inj. Solumedrol for 3 days and renal biopsy performed
- Urine output improved, and serum creatinine began falling from POD 6
- Hospital stay: Discharged on postoperative day 7
- Pain management: Oral analgesics twice daily for 7 days; resumed normal activity from POD 2
- Short-term functional outcomes: Returned to normal activity without complications
Key Takeaways / Learning Points
- Clinical significance: Robotic-assisted kidney transplant allows less pain, early mobility, better cosmetic outcomes, and comparable renal function to open transplant.
- Lessons learned: Robotic kidney transplant can be safely performed through a small Pfannenstiel incision with robotic ports, achieving excellent functional outcomes and faster recovery.
