Minimally Invasive Renal Transplantation

During the last 20 years minimally invasive surgery (MIS) has replaced many open, conventional operations and is now important in almost every facet of abdominal surgery (Harrell & Beniford, 2005). Benefits regarding postoperative pain, convalescence, return to normal activities, and cosmetic results have been proven for a wide range of MIS procedures. Within the field of transplantation, laparoscopic fenestration of lymphoceles in kidney recipients was first described in 1991 (McCullough et al.). Furthermore, laparoscopic living donor nephrectomy (L-LDN) has gained widespread acceptance, since the first procedure was performed in Baltimore, USA in 1995 (Ratner et al., 1995). Reduction of tissue trauma seems particularly appropriate in the immunosuppressed population, with significantly delayed wound healing and a high “background” complication rate. Due to the immunosuppressive theraphy, the incidences of lymphoceles, wound dehiscence and incisional hernia are distinctly higher in kidney-Tx (KTx) recipients. On this background it is rather surprising that MIS techniques for the renal transplant procedure itself, first have been reported during recent years. Possible explanations for these seemingly conservative attitudes, may include the urge for safe handling of the kidney through sufficient access, for total control during revascularization; and the present unfeasibility of automating the vascular anastomoses. In 2002, however, a french case report on robotic-assisted (da Vinci system) kidney transplantation, from a deceased donor, was presented (Hoznek et al., 2002). Thereafter, no further cases/series of robotic-assisted KTx seem to have been published. In 2006 a minimally invasive KTx (MIKT) technique was described in Transplantation and Transplantation Proceedings (Øyen et al., 2006); using a minimal skin incision (7-9 cm) and still giving optimal access to the anastomotic area of the iliac vessels mostly without using scopic aid. Twentyone consecutive MIKT procedures, performed by a single surgeon was compared to a control group subjected to conventional KTx. Since then, a South Korean group has published two reports (Seong-Pyo et al., 2007; Park et al., 2008) on a videoassisted MIKT technique. Another MIKT report was contributed by a spanish group (Rosales et al., 2010); a case report describing a laparoscopic KTx technique, without robotic assistance. Furthermore, in 2010 a minimally invasive technique for renal auto-transplantation was reported (Øyen et al., 2010); by combining ‘handassisted laparoscopic nephrectomy’’ and