This study focuses on a novel vascular anastomosis technique in robotic-assisted kidney transplantation (RAKT) designed to reduce rewarm ischemia time, a critical factor in transplant success. RAKT procedures, which are currently performed in select medical centers globally, rely heavily on precise vascular anastomosis—a step directly linked to minimizing ischemia. This study introduces a “Preplaced Knot” technique, which modifies the standard Vattikuti-Medanta method by adding a pre-tied knot to the sutures, potentially improving efficiency. During venous anastomosis, two Gore-Tex sutures, each cut to 3.75 inches, are used with an extracorporeally tied knot between them. The arterial anastomosis process was also refined to further optimize performance.
The study included 50 paired patients with single-vessel renal allografts, split into two groups. Group 1 underwent the conventional technique, which required three distinct knot ties for both venous and arterial anastomosis. Group 2 received the Preplaced Knot technique, which reduced knotting to only one point for venous anastomosis and two points for arterial anastomosis. Results showed a statistically significant reduction in both venous anastomosis time and overall rewarm ischemia time for the Preplaced Knot group. Specifically, venous anastomosis time decreased by an average of three minutes, while the overall rewarm ischemia time was reduced by seven minutes (p < 0.5).
The Preplaced Knot technique offers an effective way to simplify vascular anastomosis, which could reduce the need for bedside assistance and streamline the procedure. The ease of implementing this technique suggests that it could be widely adopted to enhance the efficiency of RAKT, thus potentially improving transplant outcomes. The study did not receive external funding.
