Renal Autotransplantation; Case Series

Study Overview
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Brief Summary
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Renal autotransplantation (RAT) is a method of removing a kidney from its place of origin in a patient, repairing it, and transplanting it in another location of the body, generally the iliac fossa of the same patient.RAT is a relatively new technique; the first ever RAT procedure in the US was performed in 1963. Advances in preservation and transplantation techniques have made RAT a modality that can be utilized in complex renal diseases. RAT is indicated for conditions such as renal vascular disease, nutcracker syndrome, pelvic venous congestion, pelvic trauma, refractory stone disease and, in some cases, loin pain hematuria syndrome and conventionally unresectable renal tumors. Irrespective of the excellent outcomes shown by RAT, the conventional open approach requires a large midline xiphoid-to-pubis or flank incision for donor nephrectomy with a second pelvic incision for renal transplantation into the iliac fossa.The current gold standard approach to RAT is a laparoscopic nephrectomy followed by open auto-transplantation. However, this approach still requires a large pelvic incision. Robotic technology enables us to perform more complex minimally invasive surgery. Gordon et al. performed and reported the first completely intracorporeal robotic RAT to repair a ureteral injury in 2014.

Detailed Description
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This is a retrospective chart review case series study of all consecutive cases in which robotic RAT was performed that meet the study inclusion and exclusion criteria. The case series will be performed starting from January 2018 until June 2021 to include all cases of robotic RAT procedures. Perioperative and short-term clinical data will be obtained from the EMR. All the data variables will be documented in the case report forms. Because the data will have been de-identified and is archival in nature, there will be no active subject recruitment and no patient consenting is required.

Official Title
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Renal Autotransplantation; Case Series

Conditions
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Renal Vascular Disease, Nutcracker Syndrome, Renal, Pelvic Trauma, Loin Pain-Hematuria Syndrome, Renal Tumor, Congestion, Venous

Intervention / Treatment
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* Procedure: Pre-Operative Information
* Procedure: Intra-Operative Data
* Other: Post-Operative Data (up to discharge)
* Other: Short-Term Follow-Up Data


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Subject was 18 years or older at the time of the procedure Subject who has undergone robotic RAT irrespective of the underlying etiology. Exclusion Criteria: Subjects who do not meet the inclusion criteria

Ages Eligible for Study
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Minimum Age: 18 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| RAT<br>patients having undergone robotic-assisted RAT procedure | Procedure: Pre-Operative Information<br>* Demographics (e.g., age, gender), patient characteristics (e.g., BMI, American Society of Anesthesiologists class), and pre-operative medical history (e.g., tobacco use; comorbidities: hypertension, cardiopulmonary disease, diabetes; indication for RAT; lesions; previous renal revascularization; serum creatinine level).<br>Procedure: Intra-Operative Data<br>* Operative time, total OR time, concomitant procedures, transfusions, conversions, intraoperative adverse events, autotransplantation technique<br>Other: Post-Operative Data (up to discharge)<br>* Postoperative adverse events, discharge status, hospital length of stay, information on enhanced recovery program<br>Other: Short-Term Follow-Up Data<br>* Adverse events, re- admissions, re-operations related to the index procedure<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Baseline patient characteristics | Demographics-age | January 2018 until June 2021 | 
| Baseline patient characteristics- BMI | BMI, based on the American Society of Anesthesiologists status classification | January 2018 until June 2021 | 
| Baseline patient characteristics- Tobacco use | Medical History: tobacco use | January 2018 until June 2021 | 
| Baseline patient characteristics- Gender | Demographics: gender | January 2018 until June 2021 | 
| Baseline patient characteristics- Hypertension | Medical History: hypertension | January 2018 until June 2021 | 
| Baseline patient characteristics- Diabetes | Medical History: diabetes | January 2018 until June 2021 | 
| Baseline patient characteristics-cardiopulmonary disease | Medical History: cardiopulmonary disease | January 2018 until June 2021 | 
| Baseline patient characteristics-indication for RAT (Renal Autotransplantation | Medical History: indication for RAT (Renal Autotransplantation) | January 2018 until June 2021 | 
| Baseline patient characteristics-lesions | Medical History: lesions | January 2018 until June 2021 | 
| Baseline patient characteristics-previous renal revascularization | Medical History: previous renal revascularization | January 2018 until June 2021 | 
| Baseline patient characteristics-serum creatinine level | Medical History: serum creatinine level | January 2018 until June 2021 | 
| short-term clinical data-Adverse events, | Adverse events, re- admissions, re-operations related to the index procedure | up to 30 days post discharge | 
| intraoperative characteristics-Operative time | Operative time | January 2018 until June 2021 | 
| intraoperative characteristics-total OR time | total OR time | January 2018 until June 2021 | 
| intraoperative characteristics-concomitant procedures | concomitant procedures | January 2018 until June 2021 | 
| intraoperative characteristics-transfusions | transfusions | January 2018 until June 2021 | 
| intraoperative characteristics-conversions | conversions | January 2018 until June 2021 | 
| intraoperative characteristics-intraoperative adverse events | intraoperative adverse events | January 2018 until June 2021 | 
| intraoperative characteristics-autotransplantation technique | autotransplantation technique | January 2018 until June 2021 | 
| post-operative characteristics-Post-operative adverse events | Post-operative adverse events | January 2018 until June 2021 | 
| post-operative characteristics-discharge status | discharge status | January 2018 until June 2021 | 
| post-operative characteristics-hospital length of stay | hospital length of stay | January 2018 until June 2021 | 
| post-operative characteristics-information on enhanced recovery program | information on enhanced recovery program | January 2018 until June 2021 |