Robotic-assisted Kidney Autotransplantation for Nutcracker Syndrome: Surgical Technique and Results

Background and objective

The nutcracker syndrome is a rare condition that occurs in young patients and can cause severe flank pain. The available surgical techniques often carry a risk of complications or morbidity. This study aims to describe robotic-assisted kidney autotransplantation for nutcracker syndrome and show its efficacy and safety.

Methods and surgical procedure

A retrospective study of all patients managed in our center by robotic-assisted kidney autotransplantation for symptomatic nutcracker syndrome was carried out. Patient demographics, operative time, hospitalization time, complications, management of postoperative pain, and patient-reported outcome measures (PROMs) were assessed.

Key findings and limitations

Thirty-four patients (30 female and four male) underwent surgery between January 2015 and December 2024, with a median age of 35 (Q1–Q3: 27–43) yr and a median body mass index of 20 kg/m². The median operative time was 314 (Q1–Q3: 265–350) min, and the median hospital stay was 3 d. One procedure was converted to open surgery. Seven patients (21%) experienced complications within 3 mo, including five minor (Clavien-Dindo grade <3) and two major (Clavien-Dindo ≥3) complications, one of which required a nephrectomy. The median follow-up was 15 (Q1–Q3: 6–30) mo. PROMs were available for 29 patients. Nine patients (31%) reported complete symptom relief, 17 (59%) partial improvement, and three (10%) partial worsening of their symptoms.

Conclusions and clinical implications

Robotic-assisted kidney autotransplantation can be a therapeutic option for the treatment of nutcracker syndrome, but it should be performed in an expert center for transplantation and robotic surgery. Further studies and long-term follow-up are needed.