V08-01 robotic bladder autotransplantation in a brain-dead heart-beating deceased donor: wet run before a first-in-human clinical trial

You have accessJournal of UrologyCME1 Apr 2023V08-01 ROBOTIC BLADDER AUTOTRANSPLANTATION IN A BRAIN-DEAD HEART-BEATING DECEASED DONOR: WET RUN BEFORE A FIRST-IN-HUMAN CLINICAL TRIAL Nima Nassiri, Giovanni Cacciamani, David Ginsberg, Evgeniy Kreydin, Andre Abreu, Mihir Desai, Monish Aron, Yasir Qazi, Yuri Genyk, and Inderbir Gill Nima NassiriNima Nassiri More articles by this author , Giovanni CacciamaniGiovanni Cacciamani More articles by this author , David GinsbergDavid Ginsberg More articles by this author , Evgeniy KreydinEvgeniy Kreydin More articles by this author , Andre AbreuAndre Abreu More articles by this author , Mihir DesaiMihir Desai More articles by this author , Monish AronMonish Aron More articles by this author , Yasir QaziYasir Qazi More articles by this author , Yuri GenykYuri Genyk More articles by this author , and Inderbir GillInderbir Gill More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000003306.01AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: Bladder transplantation has not yet been successfully performed. Technical challenges include complicated deep pelvic vascular anatomy, limited visualization, and procedural complexity. In preparation for a first-in-human clinical trial of bladder transplantation (NCT05462561), we performed a robotic vascularized composite bladder allograft (VCBA) autotransplantation in a brain-dead heart-beating research donor. METHODS: An appropriate research donor was identified by our local organ procurement organization. VCBA autotransplantation was performed, including VCBA dissection, extracorporeal back-tabling, vascular reanastomoses, and vesicourethral anastomosis. A robotic approach was necessary to optimize visualization in the deep pelvis and maximally preserve allograft perfusion. The primary objective was to develop the stepwise procedure and gauge its technical success, defined by autograft perfusion by direct visual inspection and indigo-cyanine green (ICG) fluorescence. Secondary objectives included intraoperative parameters (operative times, warm ischemia time, and EBL). IRB (HS-21-00162) approval was obtained. RESULTS: Technical success, defined by adequate autograft perfusion after vascular anastomosis, was achieved. In the brain-dead heart beating donor, the technical maneuvers were well tolerated, with intra-operative hemodynamic stability (Table 1). Operative time was 670 min. Visual inspection revealed a pink, healthy bladder and patent vascular anastomoses, with diffuse ICG uptake. CONCLUSIONS: This is the first documented case of robotic bladder autotransplantation, performed in a brain-dead heart-beating research donor as a necessary preclinical step towards a first-in-human trial of bladder transplantation (NCT05462561). Technical feasibility was demonstrated, and vascular viability was confirmed by ICG uptake. The robotic approach was necessary for fine vascular dissection in the deep pelvis. Source of Funding: This study has been supported by a clinical research grant from the OneLegacy Foundation. © 2023 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 209Issue Supplement 4April 2023Page: e748 Advertisement Copyright & Permissions© 2023 by American Urological Association Education and Research, Inc.MetricsAuthor Information Nima Nassiri More articles by this author Giovanni Cacciamani More articles by this author David Ginsberg More articles by this author Evgeniy Kreydin More articles by this author Andre Abreu More articles by this author Mihir Desai More articles by this author Monish Aron More articles by this author Yasir Qazi More articles by this author Yuri Genyk More articles by this author Inderbir Gill More articles by this author Expand All Advertisement PDF downloadLoading ...