EDITORIAL COMMENT

Minimally invasive, especially robot-assisted kidney transplantation (RKT) is of interest, however, concerns have been raised about possible increases in warm ischemia times.  For this purpose, the authors have compared ischemia-reperfusion injuries after open or RKT in a porcine model and also have described a novel intra-abdominal cooling system aimed at reducing kidney rewarming during the procedure. After performing standard open donor nephrectomy, the kidneys were transplanted with standard open technique with intermittent 4 ⁰C saline cooling (group 1), RKT without (group 2) and with continuous intra-abdominal cooling (group 3). Group 1 had the shortest vascular anastomosis time while the other 2 groups had similar vascular anastomosis duration. Group 3 maintained lower renal cortex temperatures throughout the procedure when compared to other two groups. Magnetic resonance imaging showed that parenchymal heterogeneities and histologic ischemia-reperfusion lesions were more severe in the robotic group without cooling than in the open surgery and the robot-assisted group with cooling groups. Reperfusion injuries are more prone to occur during RKT without efficient kidney cooling. The use of a novel intraoperative cooling device may successfully prevent ischemia-reperfusion injuries in the era of minimally invasive surgery.