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Introduction: Horseshoe kidney (HSK), a congenital anomaly, presents unique challenges for transplant surgeons due to its complex vascular and collecting system anatomy. The use of HSK as a donor remains controversial, although cases have been performed most frequently in deceased donor transplants, and some have even tried open and laparoscopic approaches in living donors. Typically, in these cases, the isthmus was thin, fibrous and lacked a separate blood supply. In this video, we demonstrate our technique and share the outcome of the world's first robot-assisted donor nephrectomy in HSK for parenchymatous isthmus with multiple vessels. Materials and methods: A 49-year-old female, voluntary kidney donor for her husband, was found to have HSK. The renal scan indicated equal function of both moieties. The right moiety was supplied by a main renal artery and branches of a common lower polar artery. The left moiety was supplied by a main renal artery and two accessory lower polar arteries. One common lower polar renal artery was seen arising from the anterior aspect of the aorta supplying bilateral lower poles and isthmus. She was planned for robot-assisted donor nephrectomy of the right moiety in HSK, as there were no alternate donors. Results: The main right renal artery, along with the accessory arteries to the isthmus, were dissected out. The level of demarcation over the parenchymatous isthmus was noted in firefly mode after injecting intravenous indocyanine green (ICG) dye. Pantaloon anastomosis for both accessory arteries, along with renorrhaphy of the isthmus, was done on bench. The recipient underwent an open kidney transplant; the main right renal artery was anastomosed with the right common iliac artery, and the pantaloon created was anastomosed to the right external iliac artery. The intra and postoperative courses for both donor and recipient were uneventful. Renal function remained stable in both, with no complications, throughout the follow-up of 20 months. Conclusions: Retrieving a living-donor HSK presents significant technical challenges in removing a moiety without compromising the function of the other. Given the global shortage of donor kidneys, utilizing a donor with HSK could be a viable and safe option in experienced hands. We utilized the robotic platform, enhanced with ICG and firefly mode, to successfully complete this challenging procedure.

Introduction: Kidney transplantation remains the gold standard treatment for patients with end-stage renal disease. While open surgery has long been the traditional approach, robot-assisted kidney transplant (RAKT) has emerged as a viable alternative. One of the key challenges in RAKT is managing multiple vessel renal allografts. Successful transplantation of an angiomyolipoma (AML)-affected kidney has been reported after its excision on the bench. However, it is still often seen, as a relative contraindication to transplantation. In this video, we demonstrate our innovative technique and share the outcome of managing AML and triple vessel allograft in RAKT using an internal iliac artery autograft. Materials and Methods: A 50-year-old male patient was planned for RAKT. Pre-operative workup of the donor revealed two renal arteries on the left side and three renal arteries on the right side. Also, there was a 3 × 3 cm mass in the right kidney, which, on computed tomography, was characteristic of AML. Radio-isotope renogram study revealed equal function of both kidneys, 54.2 and 45.2 mL/min on the right and left side, respectively. A decision was made to take the right kidney laparoscopically for transplantation and remove the mass at bench dissection. The surgery was divided into three distinct steps. Step 1 was the robotic retrieval of the internal iliac artery autograft from the recipient. Step 2 involved bench dissection, which included ex-vivo vascular reconstruction to anastomose three renal arteries with internal iliac artery autograft, and excision of AML with renorrhaphy. Two upper polar arteries were anastomosed in pantaloon fashion, and this pantaloon was then anastomosed end-to-end with the autograft. The lower polar artery was reimplanted in an end-to-side fashion on the autograft. Step 3 is the anastomosis of this autograft-allograft complex with the external iliac vessels of the recipient. Results: By creating the autograft-allograft complex, we were able to fashion a single arterial ostium that subsequently led to a single arterial anastomosis with the external iliac artery. Cold and rewarm ischemia times were 100 and 36 min, respectively. The intra and postoperative courses for both donor and recipient were uneventful. Renal function remained stable in both, with no complications, throughout the follow-up of 20 months. Conclusions: This innovative technique of using internal iliac artery autograft offers reduced rewarm ischemia in robot-assisted kidney transplant, the same as that of a single vessel, and eliminates the need for more than one intracorporeal arterial anastomosis. Incidental or asymptomatic small benign renal masses in donor kidneys can be considered for transplantation after being thoroughly evaluated for their suitability, rather than rejected outright.

Introduction: Prostate cancers are infiltrated with Programmed Death-1 (PD-1) expressing Cluster of Differentiation (CD)8+ T-cells which interact with Programmed cell Death Ligand-1 (PDL-1) receptors on Tumour Cells (TC). However, in many studies, male with prostate cancer did not respond to monotherapy (PDL blockade). This unresponsiveness could be due to the fact that prostate cancer usually does not express PDL-1. The PDL-1 expression has demonstrated a significant correlation with increased risk of disease progression in various tumours but data regarding its role in prostate cancer is conflicting. Aim: To study the occurrence rate of PDL-1 expression and its association with tumour aggressiveness in prostate cancer. Materials and Methods: This cross-sectional observational study was conducted at ABVIMS and Dr. Ram Manohar Hospital, New Delhi, India, from October 1st, 2018 to April 30th, 2020. A total of 120 males with prostate cancer who had their diagnosis established by a prostate biopsy were included. Histopathology reports were analysed and PDL-1 immunohistochemical staining was carried out with PDL-1 monoclonal antibodies. PDL-1 expression on TCs was defined by the percentage of PDL-1 positive TCs (40), high Gleason score (≥7), distant metastasis and cases with lymphovascular invasion. Conclusion: Present study suggests that PDL-1 is associated with the tumour aggressiveness in prostate cancer patients and can be used for the identification of more aggressive diseases.