Robotic-assisted simultaneous kidney-pancreas transplantation (RASPKT) without hand assistance: A retrospective cohort study showing a paradigm shift in minimally invasive transplant surgery.

Abstract

Simultaneous pancreas-kidney transplantation is the best option for patients with type 1 diabetes mellitus and end-stage kidney disease; however, the conventional open surgical approach is associated with a significant risk of pancreas allograft thrombosis, high morbidity, and prolonged hospital stays. Robotic-assisted simultaneous pancreas-kidney transplantation represents a paradigm shift in minimally invasive transplant surgery, offering the potential to reduce early postoperative complications. However, robotic-assisted simultaneous pancreas-kidney transplantation remains technically challenging, with previous approaches requiring GelPort device hand assistance in performing vascular and bowel anastomoses. In a retrospective cohort study, 4 patients underwent robotic-assisted simultaneous pancreas-kidney transplantation at our center using an intra-abdominal, hands-free robotic technique between September 2023 and November 2024. Early postoperative outcomes and measures of pancreas/kidney allograft function during the first 3-12 months posttransplant were analyzed. Median operative time was 467.5 minutes (range, 399-543 minutes), with median pancreas and kidney warm ischemia times of 67 minutes and 57 minutes, respectively. Median length of hospital stay was 13.5 days (range, 8-18 days). No patients experienced vascular, urologic, or surgical complications; additionally, no pancreas allograft thrombosis nor rejection was observed. At 3 months posttransplant, all recipients achieved insulin independence, with glycated hemoglobin levels ≤5% and C-peptide levels ≥2.5 ng/mL. Kidney allografts also functioned effectively, with estimated glomerular filtration rates ranging from 37 mL/min to >90 mL/min and stable creatinine levels (0.7-1.82 mg/dL). This fully intra-abdominal, hands-free robotic approach to robotic-assisted simultaneous pancreas-kidney transplantation appears to be technically feasible and safe to perform, with excellent early clinical outcomes. However, larger studies with longer follow-up are required to confirm its clinical benefits and broader applicability.