2 The condition, current treatments and procedure
2.1 End-stage renal disease happens when kidney function is insufficient to maintain health without either dialysis or a kidney transplant. This is typically when the glomerular filtration rate is less than 15 ml/min/1.73 m2. End-stage renal disease may be caused by a number of conditions, most commonly diabetes.
2.2 The treatments for end-stage renal disease include conservative treatment, dialysis and kidney transplant. Kidney transplant is considered the treatment of choice for many patients but is not always possible.
2.3 Kidney transplant, using a kidney from either a deceased or living donor, is usually done by open surgery through an incision in the left or right lower abdomen providing a retroperitoneal approach to the iliac fossa.
2.4 Robot-assisted kidney transplants may result in decreased blood loss, shorter recovery time, fewer wound complications and improved cosmetic results compared with conventional open surgery.
2.5 With the patient under general anaesthesia and placed in a supine position, a periumbilical incision of about 7 cm is made to insert a hand-assist device. Then, 4 or 5 small incisions (0.5 cm to 1 cm) are made to insert robotic arms and instruments into the abdomen. After the ports and the hand-assist device are in place, the patient is usually moved to the Trendelenburg position. The external iliac vessels are prepared and the bladder is filled with normal saline to facilitate its dissection. The graft kidney is put into the peritoneum, and the renal vein and artery are anastomosed to the external iliac vessels using the robot. After completion of vascular anastomoses, an ureteroneocystostomy is done robotically. The patient's wounds are then sutured. Intra-operative Doppler imaging may be used to assess graft vascular flow.
2.6 Modifications of the techniques used for robot-assisted kidney transplant have been described.