This study explores an innovative technique for vascular anastomosis in robotic-assisted kidney transplants (RAKT) aimed at reducing rewarm ischemia time. RAKT procedures, pioneered by the Vattikuti-Medanta technique, are performed in select centers worldwide. Vascular anastomosis is one of the most critical steps in RAKT, directly impacting rewarm ischemia time, which is crucial for successful kidney function post-transplant. This study introduces a modification using a pre-placed knot technique for suturing, which potentially shortens the procedure. In this method, venous anastomosis is completed using two Gore-Tex sutures, each trimmed to 3.75 inches. A knot is tied extracorporeally between the sutures, eliminating additional tying steps. For arterial anastomosis, the technique was further adjusted to reduce knot tying frequency.
The study included 50 paired patients with single-vessel renal allografts, divided into two groups. In group 1, the traditional method was used, where multiple knots were tied at three distinct points during both venous and arterial anastomoses. In group 2, the pre-placed knot technique was employed, requiring only one knot during venous and two during arterial anastomoses. Results showed a significant decrease in venous anastomosis time by an average of three minutes (p<0.5) and an overall reduction in rewarm ischemia time by seven minutes (p<0.5) for patients using the pre-placed knot technique.
The findings highlight that the pre-placed knot technique can effectively reduce rewarm ischemia time, offering a reproducible and straightforward approach that minimizes reliance on the bedside assistant. This method could be a valuable improvement in RAKT, potentially enhancing patient outcomes by reducing critical ischemia times.
