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Afferi L, Gallioli A, Territo A, Cannoletta D, Mestdagh K, Vangeneugden J, Van Praet C, Desender L, Mercier J, Prudhomme T, Salamone V, Fontana G, Albisinni S, Osswald R, John H, Etcheverry B, Vigués F, Doumerc N, Minervini A, Palou J, Decaestecker K, Breda A. Robotic ileal ureter replacement vs kidney autotransplantation for long ureteric strictures. BJU Int 2025; 135:1031-1038. [PMID: 40066829 DOI: 10.1111/bju.16704] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2025]
Abstract
OBJECTIVE To compare functional and surgical outcomes of robot-assisted ileal ureter replacement (RAIUR) vs robot-assisted kidney autotransplantation (RAKAT). PATIENTS AND METHODS This was a retrospective analysis of patients who underwent RAIUR or RAKAT for long ureteric strictures at eight European tertiary centres (2017-2024). Primary endpoints were maintenance of estimated glomerular filtration rate (eGFR) and postoperative complications within 30 days of surgery, described using the Clavien-Dindo classification. Secondary outcomes included infections, need for lifelong drainage, stricture persistence, and re-intervention for the stricture during follow-up. RESULTS A total of 15 and 39 patients underwent RAIUR and RAKAT, respectively. The patients who underwent RAIUR were older (61 vs 45 years, P = 0.03), with more comorbidities (Charlson Comorbidity Index ≥3: 67% vs 28%, P = 0.03) and had a lower baseline eGFR (60 vs 87 mL/min/1.73m2, P = 0.007). The median stricture length was 9.6 cm for RAIUR vs 7 cm for RAKAT. Patients who underwent RAIUR had a shorter surgical time (290 vs 355 min, P = 0.008), whereas those who underwent RAKAT had a shorter hospitalisation (5 vs 8 days, P = 0.001). Overall complications were higher after RAIUR (73% vs 31%, P = 0.01), but Clavien-Dindo Grade ≥III complications were similar (13% vs 10%). During follow-up, both groups showed slightly improved renal function, low infection rates (13% for RAIUR vs 10% for RAKAT), low stricture persistence (13% for RAIUR vs 7.7% for RAKAT), and minimal need for drainage or re-intervention. The main limitation was the modest sample size. CONCLUSION In the first comparative analysis of RAIUR and RAKAT, we provide evidence that both techniques provide similar improvements in renal function and similar rates of postoperative high-grade complications. Both approaches represent definitive solutions for ureteric strictures in most patients. The choice of the technique should be based on patients' factors, patients' expectations and the surgeon's experience.
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Affiliation(s)
- Luca Afferi
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, Luzerner Kantonsspital, Lucerne, Switzerland
- Department of Urology, Kantonsspital Aarau, Aarau, Switzerland
| | | | - Angelo Territo
- Department of Urology, Fundació Puigvert, Barcelona, Spain
| | - Donato Cannoletta
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Division of Oncology/Unit of Urology, Soldera Prostate Cancer Laboratory, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | | | | | | | - Jeremy Mercier
- Department of Urology, Hospital of Toulouse, Toulouse, France
| | | | - Vincenzo Salamone
- Department of Experimental and Clinical Medicine, Unit of Oncology, University of Florence, Florence, Spain
| | - Giovanni Fontana
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- School of Medicine, Humanitas University, Milan, Italy
| | | | - Ricardo Osswald
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | - Hubert John
- Department of Urology, Kantonsspital Winterthur, Winterthur, Switzerland
| | | | | | - Nicolas Doumerc
- Department of Urology, Hospital of Toulouse, Toulouse, France
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, Unit of Oncology, University of Florence, Florence, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
| | - Karel Decaestecker
- AZMM AZ Maria Middelares, Ghent, Belgium
- Department of Urology, Uz Gent, Ghent, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Barcelona, Spain
- Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain
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Territo A, Afferi L, Musquera M, Gaya Sopena JM, Pecoraro A, Campi R, Gallioli A, Etcheverry B, Prudhomme T, Vangeneugden J, Ortved M, Røder A, Zeuschner P, Volpe A, Garcia-Baquero R, Kocak B, Mirza I, Stockle M, Canda E, Fornara P, Rohrsted M, Doumerc N, Decaestecker K, Serni S, Vigues F, Alcaraz A, Breda A. Robot-assisted Kidney Transplantation: The 8-year European Experience. Eur Urol 2025; 87:468-475. [PMID: 39794184 DOI: 10.1016/j.eururo.2024.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 11/30/2024] [Accepted: 12/13/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND AND OBJECTIVE Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. METHODS This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30 d) and late (from 31 to 90 d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. KEY FINDINGS AND LIMITATIONS A total of 624 patients with a median age of 35 yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73 m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23 mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group. CONCLUSIONS AND CLINICAL IMPLICATIONS With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Luca Afferi
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya Sopena
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Alessio Pecoraro
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Begoña Etcheverry
- Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Joris Vangeneugden
- Department of Urology, University Hospital Ghent, Ghent, Belgium (ERN eUROGEN accredited center)
| | - Milla Ortved
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Røder
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Philip Zeuschner
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Rodrigo Garcia-Baquero
- Kidney Transplant Unit, Urology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Burak Kocak
- Koç University Hospital Organ Transplant Center, İstanbul, Turkey; Department of Urology, Koç University School of Medicine, İstanbul, Turkey
| | - Idu Mirza
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Michael Stockle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Erdem Canda
- Koç University Hospital Organ Transplant Center, İstanbul, Turkey; Department of Urology, Koç University School of Medicine, İstanbul, Turkey
| | - Paolo Fornara
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Malene Rohrsted
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Karel Decaestecker
- Department of Urology, University Hospital Ghent, Ghent, Belgium (ERN eUROGEN accredited center)
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesc Vigues
- Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
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Gong M, Jiang Y, Sun Y, Liao R, Liu Y, Yan Z, He A, Zhou M, Yang J, Wu Y, Wu Z, Huang Z, Wu H, Jiang L. Knowledge domain and frontier trends of artificial intelligence applied in solid organ transplantation: A visualization analysis. Int J Med Inform 2025; 195:105782. [PMID: 39761617 DOI: 10.1016/j.ijmedinf.2024.105782] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2024] [Revised: 12/30/2024] [Accepted: 12/30/2024] [Indexed: 02/12/2025]
Abstract
BACKGROUND Solid organ transplantation (SOT) is vital for end-stage organ failure but faces challenges like organ shortage and rejection. Artificial intelligence (AI) offers potential to improve outcomes through better matching, success prediction, and automation. However, the evolution of AI in SOT research remains underexplored. This study uses bibliometric analysis to identify trends, hotspots, and key contributors in the field. METHODS 821 articles from the Web of Science Core Collection were exported for analysis. Microsoft Excel 2021 was used for descriptive statistics. VOSviewer, CiteSpace, Scimago Graphica, and Biblioshiny were used for bibliometric analysis. The ggalluvial package in R was utilized to create Sankey diagrams, and top articles were selected based on citation count. RESULTS This analysis reveals the rapid expansion of AI in SOT. Key areas include robotic surgery, organ allocation, outcome prediction, immunosuppression management, and precision medicine. Robotic surgery has improved transplant outcomes. AI algorithms optimize organ matching and enhance fairness. Machine learning models predict outcomes and guide treatment, while AI-based systems advance personalized immunosuppression. AI in precision medicine, including diagnostics and imaging, is crucial for transplant success. CONCLUSION This study highlights AI's transformative potential in SOT, with significant contributions from countries like the USA, Canada, and the UK. Key institutions such as the University of Toronto and the University of Pittsburgh have played vital roles. However, practical challenges like ethical issues, bias, and data integration remain. Fostering international and interdisciplinary collaborations is crucial for overcoming these challenges and accelerating AI's integration into clinical practice, ultimately improving patient outcomes.
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Affiliation(s)
- Miao Gong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingsong Jiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yingshuo Sun
- Department of Obstetrics and Gynecology, Jinan Central Hospital of Shandong Province, Jinan, Shandong, China
| | - Rui Liao
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Yanyao Liu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zikang Yan
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Aiting He
- Department of Hepatobiliary Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Mingming Zhou
- Department of Hepatobiliary Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Jie Yang
- Department of Hepatobiliary Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, China
| | - Yongzhong Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Zhongjun Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - ZuoTian Huang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China; Department of Hepatobiliary Pancreatic Tumor Center, Chongqing University Cancer Hospital, Chongqing, China.
| | - Hao Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
| | - Liqing Jiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China.
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Kim JM, Kwon HE, Ko Y, Jung JH, Kwon H, Kim YH, Shin S. A comparative study on outcomes of ABO-incompatible kidney transplants between robot-assisted vs. open surgery-propensity score-matched analysis: a retrospective cohort study. BMC Nephrol 2024; 25:410. [PMID: 39543527 PMCID: PMC11566057 DOI: 10.1186/s12882-024-03842-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2024] [Accepted: 10/30/2024] [Indexed: 11/17/2024] Open
Abstract
BACKGROUND Robot-assisted kidney transplantation (RAKT) is increasingly being adopted worldwide. Despite this growing interest, there remains a notable gap in the literature, especially concerning its effectiveness in immunologically high-risk patients compared to conventional open kidney transplantation (OKT). This study investigates the viability and success of RAKT in comparison with OKT, particularly for recipients with ABO incompatibility (ABOi). METHODS This retrospective, single-center study included 239 living-donor transplants between October 2020 and February 2023, with 210 patients undergoing ABOi-OKT and 29 undergoing ABOi-RAKT. A composite of biopsy-proven acute rejection (BPAR), graft failure, and the development of de novo donor-specific antibodies was analyzed through univariate and multivariate models. Propensity score matching (PSM) was utilized to ensure a balanced comparison between the two groups. Following PSM, a total of 131 cases in the OKT group and 26 cases in the RAKT group were analyzed. RESULTS After PSM, the mean recipient age was 48.56 years for OKT and 47.96 years for RAKT. Both groups had comparable one-year (RAKT: 92.4%, OKT: 93.1%) and two-year BPAR-free survival rates (RAKT: 92.4%, OKT: 91.9%). Mean estimated glomerular filtration rate values were similar at 12 months post-transplant (RAKT: 62.15 ml/min/1.73 m², OKT: 64.53 ml/min/1.73 m²). Operative times were significantly longer for RAKT (291.42 vs. 150.81 min, p < 0.001), while cold ischemic time was also longer for RAKT (119.77 vs. 47.22 min, p < 0.001). Hospital stays were shorter for RAKT (median 6 vs. 8 days, p < 0.001). There was no significant difference in the composite outcome of BPAR, graft failure, and de novo donor-specific antibodies between the two groups (HR 0.858, 95% CI: 0.180-4.096, p = 0.848). CONCLUSIONS RAKT is a safe and effective alternative to OKT in ABOi patients, demonstrating similar perioperative outcomes, graft survival rates, and renal function. The application of ropensity score matching analysis strengthens the reliability of these findings, confirming RAKT's viability for high-risk kidney transplant recipients. TRIAL REGISTRATION The clinical trial associated with this study was registered on 2024-02-24 with the Clinical Trial Number NCT06287008|| https://www. CLINICALTRIALS gov/ ).
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Affiliation(s)
- Jin-Myung Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hye Eun Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Youngmin Ko
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Joo Hee Jung
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Hyunwook Kwon
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Young Hoon Kim
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea
| | - Sung Shin
- Division of Kidney and Pancreas Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, 05505, Republic of Korea.
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Basile G, Pecoraro A, Gallioli A, Territo A, Berquin C, Robalino J, Bravo A, Huguet J, Rodriguez-Faba Ó, Gavrilov P, Facundo C, Guirado L, Gaya JM, Palou J, Breda A. Robotic kidney transplantation. Nat Rev Urol 2024; 21:521-533. [PMID: 38480898 DOI: 10.1038/s41585-024-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 09/06/2024]
Abstract
Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patients with obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach.
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Affiliation(s)
- Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessio Pecoraro
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Camille Berquin
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre, Ghent, Belgium
| | - Jorge Robalino
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandra Bravo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Jorge Huguet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Óscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Pavel Gavrilov
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Facundo
- Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Lluis Guirado
- Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
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Zhang H, Zeng J, Fan Y, Ma M, Lin T, Song T. Continuous renal surface cooling technique (CSCT) in robotic-assisted kidney transplantation: technique and outcomes from a high-volume center: a prospective cohort study. Int J Surg 2024; 110:4143-4150. [PMID: 38742842 PMCID: PMC11254218 DOI: 10.1097/js9.0000000000001385] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Accepted: 03/10/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Robot-assisted kidney transplantation (RAKT) surgery is an advanced minimally invasive technique, albeit with extended surgical and kidney ischemia time. To safeguard kidney function, the authors have devised a continuous surface cooling method (CSCT) for intraoperative kidney cooling. MATERIALS AND METHODS Patients receiving RAKT were divided into CSCT group and conventional group. The CSCT is a custom-designed apparatus composed of a single-layer plastic bag, featuring an inflow and an outflow that create a closed circuit for the continuous flow of cooling saline. The conventional group utilized ice slush for kidney graft cooling (Vattikuti Urology Institute-Medanta Technique, VUIMT). Patients who underwent open renal transplantation during the same period were also included in the study. All patients were subject to a minimum 2-month follow-up. And 1:3 propensity score matching was used to minimize selection bias. RESULTS A total of 144 patients underwent CSCT, 47 underwent VUIMT, and 196 underwent open surgery were included in the study, while after matching, 129, 43, 129 patients were included in the three groups, respectively. The median follow-up time was 19 months. None of the patients experienced delayed graft function, patient mortality, or graft loss. After introducing the kidney into the abdominal cavity for 20 minutes, the surface temperature of the kidney in the CSCT group was notably lower compared to the VUIMT group (15.42±0.88 vs. 21.74±2.53°C, P =0.001). This temperature disparity became more pronounced at 65 min (19.74±1.61 vs. 29.82±1.63°C, P <0.001). At both 3 and 7 days post-transplantation, creatinine levels in the VUIMT group were significantly higher than those in the CSCT and open surgery groups (at 3 days, 244.13±45.61 vs. 182.51±55.47 in CSCT group, P <0.001, or vs. 182.77±61.32 in the open surgery group, P <0.001; at 7 days, 162.42±54.86 vs. 143.11±44.32 in the CSCT group, P <0.001, or vs. 135.23±45.27 in the open surgery group, P <0.001). No differences were observed in blood creatinine, estimated glomerular filtration rate, and perioperative complications between the CSCT and open surgery groups. CONCLUSION The CSCT presents a significant advantage over the traditional VUIMT method in terms of kidney cooling and early postoperative kidney function preservation. Additional research is required to ascertain whether the CSCT can enhance the long-term prognosis of kidney transplant recipients.
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Affiliation(s)
| | | | | | | | | | - Turun Song
- Department of Urology, Institute of Urology, Organ Transplantation Center, West China Hospital, Sichuan University, Chengdu, China
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Zeuschner P, Friedersdorff F, Siemer S, Stöckle M. [Robot-assisted kidney transplantation-what is new?]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:361-366. [PMID: 38378943 DOI: 10.1007/s00120-024-02293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND The first robot-assisted kidney transplantation (RAKT) was conducted in 2010, and the first time in Germany in 2016. As more than 5 years have passed, current evidence, technological developments and the latest (German) experience are presented. OBJECTIVES The current evidence and experience of RAKT was investigated from an international and German perspective. MATERIALS AND METHODS In a systemic search, relevant publications were analyzed and compared with the experiences at a German urological transplant department. RESULTS From an international perspective, RAKT can now be considered a standard procedure at experienced departments, as more than 680 RAKT have been documented in Europe. The functional results are excellent with low complication rates and good mid- to long-term functional outcomes. Although RAKT was initially only performed with living organ donations, it has also been successfully conducted with cadaveric grafts. The surgical technique can be applied in challenging and complex situations, such as for arteriosclerotic recipient vessels or for kidney transplantations in children. Although RAKT is still not widely performed in Germany, the university hospital in Marburg, the third urological department in Germany, has successfully initiated a robotic transplant program. CONCLUSIONS Compared to open kidney transplantation, robot-assisted kidney transplantation enables at least noninferior results. It further appears to translate the well-documented advantages of minimally invasive surgery to kidney transplantation. However, its spread throughout Germany is only slowly increasing, possibly because only a handful of urological departments still perform kidney transplantations.
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Affiliation(s)
- Philip Zeuschner
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
| | - Frank Friedersdorff
- Klinik für Urologie, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Deutschland
| | - Stefan Siemer
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland
| | - Michael Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland
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8
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Kauffmann EF, Napoli N, Ginesini M, Gianfaldoni C, Asta F, Salamone A, Ripolli A, Di Dato A, Vistoli F, Amorese G, Boggi U. Tips and tricks for robotic pancreatoduodenectomy with superior mesenteric/portal vein resection and reconstruction. Surg Endosc 2023; 37:3233-3245. [PMID: 36624216 PMCID: PMC10082118 DOI: 10.1007/s00464-022-09860-0] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 12/27/2022] [Indexed: 01/10/2023]
Abstract
BACKGROUND Open pancreatoduodenectomy with vein resection (OPD-VR) is now standard of care in patients who responded to neoadjuvant therapies. Feasibility of robotic pancreatoduodenectomy (RPD) with vein resection (RPD-VR) was shown, but no study provided a detailed description of the technical challenges associated with this formidable operation. Herein, we describe the trips and tricks for technically successful RPD-VR. METHODS The vascular techniques used in RPD-VR were borrowed from OPD-VR, as well as from our experience with robotic transplantation of both kidney and pancreas. Vein resection was classified into 4 types according to the international study group of pancreatic surgery. Each type of vein resection was described in detail and shown in a video. RESULTS Between October 2008 and November 2021, a total of 783 pancreatoduodenectomies were performed, including 233 OPDs-VR (29.7%). RPD was performed in 256 patients (32.6%), and RPDs-VR in 36 patients (4.5% of all pancreatoduodenectomies; 15.4% of all pancreatoduodenectomies with vein resection; 14.0% of all RPDs). In RPD-VR vein resections were: 4 type 1 (11.1%), 10 type 2 (27.8%), 12 type 3 (33.3%) and 10 type 4 (27.8%). Vascular patches used in type 2 resections were made of peritoneum (n = 8), greater saphenous vein (n = 1), and deceased donor aorta (n = 1). Interposition grafts used in type 4 resections were internal left jugular vein (n = 8), venous graft from deceased donor (n = 1) and spiral saphenous vein graft (n = 1). There was one conversion to open surgery (2.8%). Ninety-day mortality was 8.3%. There was one (2.8%) partial vein thrombosis, treated with heparin infusion. CONCLUSIONS We have reported 36 technically successful RPDs-VR. We hope that the tips and tricks provided herein can contribute to safer implementation of RPD-VR. Based on our experience, and according to data from the literature, we strongly advise that RPD-VR is performed by expert surgeons at high volume centers.
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Affiliation(s)
- Emanuele F Kauffmann
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy.
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Michael Ginesini
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Cesare Gianfaldoni
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Asta
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Alice Salamone
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Allegra Ripolli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Armando Di Dato
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Vistoli
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Via Paradisa 2, 56124, Pisa, Italy
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9
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Single port robot-assisted kidney transplantation: Extraperitoneal approach. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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10
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Li Marzi V, Pecoraro A, Gallo ML, Caroti L, Peris A, Vignolini G, Serni S, Campi R. Robot-assisted kidney transplantation: Is it getting ready for prime time? World J Transplant 2022; 12:163-174. [PMID: 36051450 PMCID: PMC9331411 DOI: 10.5500/wjt.v12.i7.163] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Revised: 03/08/2022] [Accepted: 06/17/2022] [Indexed: 02/06/2023] Open
Abstract
Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint, KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery, especially due to its potential benefits for fragile and immunocompromised recipients. It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea, Development, Exploration, Assessment, Long-term follow-up recommendations for introducing surgical innovations into real-life practice. During the last years, mirroring the Vattikuti-Medanta technique, several centers developed RAKT program worldwide, providing strong evidence about the safety and the feasibility of this procedure. However, the majority of RAKT are still performed in the living donor setting, as an “eligible” procedure, while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation. In addition, despite the spread of minimally-invasive (predominantly robotic) surgery worldwide, many KTs are still performed in an open fashion. Regardless of the type of incision employed by surgeons, open KT may lead to non-negligible risks of wound complications, especially among obese patients. Particularly, the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications. In this context, robotic surgery could offer several benefits, including providing a better exposure of the surgical field and better instrument maneuverability, as well as the possibility to integrate other technological nuances, such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.
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Affiliation(s)
- Vincenzo Li Marzi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Alessio Pecoraro
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Maria Lucia Gallo
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | | | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Careggi Hospital, Florence 50134, Italy
| | - Graziano Vignolini
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
| | - Sergio Serni
- Department of Minimally Invasive and Robotic Urologic Surgery, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
| | - Riccardo Campi
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
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11
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Karadag S, Eksi M, Ozdemir O, Kargi T, Haciislamoglu A, Evren I, Polat H, Sokmen D, Ozlu DN, Sahin S, Tugcu V. Comparison of Open and Robot-Assisted Kidney Transplantation in terms of Perioperative and Postoperative Outcomes. Int J Clin Pract 2022; 2022:2663108. [PMID: 35685484 PMCID: PMC9159158 DOI: 10.1155/2022/2663108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/16/2022] [Indexed: 11/17/2022] Open
Abstract
Background The gold standard treatment method for end-stage renal disease (ESRD) is renal transplantation (RT). RT can be done with open or minimally invasive surgical methods. We aimed to compare the outcomes between patients who underwent robot-assisted renal transplantation (RART) and open renal transplantation (ORT). Methods Data of the patients who underwent ORT or RART in two institutions between June 2015 and February 2020 were retrospectively reviewed. Patients who underwent live donor RT were included, and all donor nephrectomy procedures were performed by the laparoscopic technique. Demographic data, ischemia times, anastomosis times, operation times, and postoperative complications were recorded. Results 98 patients were included in the ORT group, while 91 patients were included in the RART group. There was a significant difference between the two groups regarding mean patient age. While total ischemia time was 86.9 ± 7 minutes in the RART group, it was calculated as 71.2 ± 3.3 minutes in the ORT group, with a significant difference. The anastomosis time was significantly shorter in the ORT group than in the RART group. The incision length and duration of hospital stay were significantly shorter, visual analogue scores were significantly lower, and estimated blood loss was less in the RART group than in the ORT group. Conclusion Both ORT and RART are effective and safe methods for treating ESRD. According to our study, RART is associated with relatively longer ischemia times but lower complication rates and higher patient comfort.
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Affiliation(s)
- Serdar Karadag
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Mithat Eksi
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Osman Ozdemir
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Taner Kargi
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Haciislamoglu
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ismail Evren
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Hakan Polat
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Dogukan Sokmen
- Department of Urology, Bahçelievler Memorial Hospital, Istanbul, Turkey
| | - Deniz Noyan Ozlu
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selcuk Sahin
- Department of Urology, University of Health Sciences Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tugcu
- Department of Urology, Bahçelievler Memorial Hospital, Istanbul, Turkey
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12
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Tzvetanov IG, Tulla KA, Di Cocco P, Spaggiari M, Benedetti E. Robotic Kidney Transplant: The Modern Era Technical Revolution. Transplantation 2022; 106:479-488. [PMID: 34288638 DOI: 10.1097/tp.0000000000003881] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Since the mid 20th century, transplantation has been a fast-developing field of contemporary medicine. The technical aspects of transplant operations were developed in the 1950s, with little significant change for >50 y. Those techniques allowed completion of various organ transplants and successful patient outcomes, but they also carried the inherent disadvantages of open surgery, such as postoperative pain, wound complications and infections, and prolonged length of hospital stay. The introduction and adoption of minimally invasive surgical techniques in the early 1990s to various surgical specialties including general, gynecologic, and urologic surgery led to significant improvements in postoperative patient care and outcomes. Organ transplantation, with its precision demanding vascular anastomoses, initially had been considered infeasible to accomplish with conventional laparoscopic devices. The institution of robotic surgical technology in the late 1990s and its subsequent wide utilization in fields of surgery changed its accessibility and acceptance. With the steady camera, 3D views, and multidirectional wrist motions, surgical robotics opened new horizons for technically demanding surgeries such as transplantation to be completed in a minimally invasive fashion. Furthermore, the hope was this technique could find a niche to treat patients who otherwise are not deemed surgical candidates in many fields including transplantation. Here in, robotics in kidney transplantation and its ability to help provide equity through access to transplantation will be discussed.
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Affiliation(s)
- Ivo G Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
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13
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Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J 2021; 15:635-643. [PMID: 35371439 PMCID: PMC8967665 DOI: 10.1093/ckj/sfab214] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Indexed: 11/14/2022] Open
Abstract
Renal transplantation has become the gold-standard treatment for the majority of patients with established renal failure. Recent decades have seen significant progress in immunosuppressive therapies and advances in post-transplant management of recipients, resulting in improved graft and patient outcomes. However, the open technique of allograft implantation has stood the test of time, remaining largely unchanged. In a world where major advances in surgery have been facilitated by innovations in the fields of biotechnology and medical instrumentation, minimally invasive options have been introduced for the recipient undergoing kidney transplantation. In this review we present the evolution of minimally invasive kidney transplantation, with a specific focus on robot-assisted kidney transplant and the benefits it offers to specific patient groups. We also discuss the ethical concerns that must be addressed by transplant teams considering developing or referring to robotic programs.
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Affiliation(s)
- Harry V M Spiers
- Department of Transplantation, Addenbrooke's Hospital, Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
- Department of Surgery, University of Cambridge, Cambridge, UK
| | - Videha Sharma
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Centre for Health Informatics, Division of Informatics, Imaging and Data Science, University of Manchester, Manchester, UK
| | - Alexander Woywodt
- Department of Renal Medicine, Royal Preston Hospital, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rajesh Sivaprakasam
- Department of Transplant and Robotic Surgery, Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Titus Augustine
- Department of Renal and Pancreas Transplantation, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, Manchester, UK
- Faculty of Biology, Medicine and Health, Division of Diabetes, Endocrinology and Gastroenterology, University of Manchester, Manchester, UK
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14
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Fonseka T. Evolution of techniques in robotic kidney transplantation with perspectives on future developments. LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2021. [DOI: 10.1016/j.lers.2020.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
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15
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Zhu X, Zhao Y, Han X, Li Y, Zhang P, Wang S, Li G, Xiang C. Extraperitoneal Laparoscopic Kidney Transplantation: Preliminary Clinical Experiences from China. Adv Ther 2021; 38:1677-1689. [PMID: 33580484 DOI: 10.1007/s12325-021-01639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report on the pioneering clinical experiences of six cases of extraperitoneal laparoscopic kidney transplantation in China. METHODS For the first time in clinical practice, a customised, controllable double-circulation cooling device was used to protect the transplanted kidney. Of the six patients, two underwent an allograft renal transplantation because they had been diagnosed with uraemia and were on maintenance haemodialysis. The other four patients underwent kidney autotransplantation because of a central renal tumour. RESULTS The extraperitoneal laparoscopic kidney transplantations were successfully completed between 2017 and 2018. The operative time for the two patients undergoing the allograft transplantation was 3-3.5 h. The time for venous anastomosis was approximately 53-65 min, and the time for arterial anastomosis was approximately 25-30 min. The creatinine level was 90-80 μmol/L after surgery. The operative time of the four patients who underwent autotransplantation was 9.4-17.5 h. The times of venous and arterial anastomosis were 58-90 min and 35-48 min, respectively. The follow-up B-mode ultrasound after surgery showed good blood supply in the spared nephron. A renal graft was removed from one patient 6 months after surgery because of renal atrophy and dysfunction caused by poor blood supply. Five patients (two undergoing allografting and three undergoing autografting) completed the 12-month follow-up, and their renal graft function was good. CONCLUSIONS Extraperitoneal laparoscopic kidney transplantation, either allograft or autologous transplantation, is a safe and feasible procedure with a good chance of survival for the transplanted kidney. A customised cooling device is effective and practical during laparoscopic kidney transplantation.
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Affiliation(s)
- Xuhui Zhu
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongwei Zhao
- Department of Urology, Taian City Central Hospital, Taian, 271000, Shangdong, People's Republic of China
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Xiuwu Han
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China.
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
| | - Yansheng Li
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Peng Zhang
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Siyuan Wang
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Gao Li
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chunhong Xiang
- Department of Surgery and Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
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16
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Matthew AN, Hampton LJ, Autorino R, Bhati CS. Evolution of robotic-assisted kidney transplant: successes and barriers to overcome. Curr Opin Urol 2021; 31:29-36. [PMID: 33239515 DOI: 10.1097/mou.0000000000000834] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE OF REVIEW The aim of this study was to provide an updated review of robotic-assisted kidney transplant (RAKT) with an emphasis on advantages over the open kidney transplant (OKT), utility in special populations and resources available to overcome the learning curve of robotic surgery. RECENT FINDINGS The majority of the reported studies showed that RAKT and OKT have similar functional outcomes including similar ischemia times and time to postoperative normalization of creatinine. However, RAKT results in fewer wound complications, decreased estimated blood loss and pain. Given these benefits, RAKT is a promising approach for obese patient across BMI subtypes and several studies showed decreased wound complications in this population compared with the open approach. Moreover, new 3D-print techniques are promising resources for robotic simulation, which may decrease the learning curve of robotic surgery. SUMMARY Overall, RAKT is a feasible approach especially in obese patients. However, more data with long-term follow-up are needed to fully elucidate the advantages over OKT before universal implementation of this approach is possible.
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Affiliation(s)
| | | | | | - Chandra S Bhati
- Department of Transplant Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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17
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Musquera Felip M, Ajami Fardoun T, Peri Cusi L, Alcaraz Asensio A. Technique Description and Outcomes of Robotic Transvaginal-Assisted Living Donor Kidney Transplantation. Urol Int 2020; 105:148-154. [PMID: 33260186 DOI: 10.1159/000511756] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 09/19/2020] [Indexed: 11/19/2022]
Abstract
OBJECTIVE The aim of the study was to describe the surgical technique of totally robotic kidney transplantation with transvaginal insertion and to assess its safety and feasibility. METHODS It is a prospective analysis of the first 5 cases of robotic kidney transplantation with transvaginal insertion. Robotic-assisted kidney transplantation was performed after transvaginal insertion of a living donor kidney graft. Donor's and recipient's characteristics, intraoperative variables, postoperative complications, and surgical outcomes were assessed. RESULTS The median operative time was 220 min. Mean rewarming ischemia time of 53 min, with immediate diuresis. No intraoperative complications were observed. Mean hospitalization period was 9 days, with mean Cr of 1.5 mg/dL at discharge. CONCLUSIONS Robotic kidney transplantation with transvaginal insertion is feasible and safe. A greater number of procedures are required to confirm the results of this new technique.
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Affiliation(s)
| | | | - Lluis Peri Cusi
- Urology Department, Hospital Clinic of Barcelona, Barcelona, Spain
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Modi P, Kumar S, Mishra A, Chauhan R, Kute V, Patel H, Modi M. Robotic Assisted Dual Kidney Transplantation With Monolateral Iliac Vessels. Urology 2020; 144:234-240. [PMID: 32621822 DOI: 10.1016/j.urology.2020.06.030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2020] [Revised: 06/10/2020] [Accepted: 06/16/2020] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To demonstrate the surgical technique of dual kidney transplantation in ipsilateral iliac fossa using da Vinci Si robotic platform METHODS: Dual kidneys from expanded criteria deceased donor were used in single recipients using robotic platform in 6 recipients. Following bench surgery, both kidneys were again placed into preservation fluid and ice-box. Robot was docked between 2 legs of the recipient. Common iliac and external iliac vessels on right side were dissected using robotic instruments. A 7 cm pfannenstiel incision was placed and one kidney was dropped into the abdomen; external aponeurosis was closed to restore the pneumoperitoneum. First kidney vascular anastomosis was done with common iliac vessels. Second kidney was introduced through the same wound and transplanted with external iliac vessels. Both ureters were implanted separately into the bladder. RESULTS Between January 2013 and December 2017, 6 patients had dual robotic-assisted laparoscopic kidney transplantation. All procedures were carried out successfully without conversion to open operation. Mean time for venous anastomosis, arterial anastomosis and total operation were 16.4 (10-19) minutes, 17.5 (13-24) minutes, and 359.1 (265-500) minutes. Mean blood loss was 188.3 (80-300) ml. Two patients had delayed graft function. One patient expired 3 months following transplant due to pneumonia. CONCLUSION Using 7 cm Pfannenstiel incision, dual robotic-assisted laparoscopic kidney transplantation with common iliac and external iliac vessels is technically feasible.
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Affiliation(s)
- Pranjal Modi
- Smt. G. R. Doshi and Smt. K. M. Mehta Institute of Kidney Diseases and Research Centre & Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad-380016, India.
| | - Suresh Kumar
- Smt. G. R. Doshi and Smt. K. M. Mehta Institute of Kidney Diseases and Research Centre & Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad-380016, India
| | - Amit Mishra
- Smt. G. R. Doshi and Smt. K. M. Mehta Institute of Kidney Diseases and Research Centre & Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad-380016, India
| | - Rohit Chauhan
- Smt. G. R. Doshi and Smt. K. M. Mehta Institute of Kidney Diseases and Research Centre & Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad-380016, India
| | - Vivek Kute
- Smt. G. R. Doshi and Smt. K. M. Mehta Institute of Kidney Diseases and Research Centre & Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad-380016, India
| | - Himanshu Patel
- Smt. G. R. Doshi and Smt. K. M. Mehta Institute of Kidney Diseases and Research Centre & Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad-380016, India
| | - Manisha Modi
- Smt. G. R. Doshi and Smt. K. M. Mehta Institute of Kidney Diseases and Research Centre & Dr. H. L. Trivedi Institute of Transplantation Sciences, Civil Hospital Campus, Asarwa, Ahmedabad-380016, India
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Musquera M, Peri L, Ajami T, Campi R, Tugcu V, Decaestecker K, Stockle M, Fornara P, Doumerc N, Vigues F, Barod R, Desender L, Territo A, Serni S, Vignolini G, Sahin S, Zeuschner P, Banga N, Breda A, Alcaraz A. Robot-assisted kidney transplantation: update from the European Robotic Urology Section (ERUS) series. BJU Int 2020; 127:222-228. [PMID: 32770633 DOI: 10.1111/bju.15199] [Citation(s) in RCA: 38] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To report the results of the robot-assisted kidney transplantation (RAKT) experience performed in 10 European centres by members of the European Robotic Urology Section (ERUS)-RAKT group. PATIENTS AND METHODS This is a multicentre prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intraoperative outcomes, complications rate and functional results were collected and analysed. RESULTS Between July 2015 and September 2019, 291 living-donor RAKTs were performed. Recipients were mostly male (189 [65%]), the mean Standard deviation (sd) age was 45.2 (13.35) years, the mean (sd) body mass index was 27.13 (19.28) kg/m2 , and RAKT was pre-emptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used in 15.4%. The mean (sd) total surgical and re-warming time was 244 (70.5) min and 53.16 (15.27) min, respectively. In all, 17 patients presented with postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one due to acute rejection. Two patients had arterial stenosis, three had incisional hernias, six had ureteric stenosis, and nine had lymphoceles. Neither surgical nor re-warming times were correlated with postoperative serum creatinine levels (P > 0.05). Comparison of surgical data between the first 120 cases and the following 171 cases showed a significantly shorter total surgical time in the second group (265 vs 230 min, P = 0.005). CONCLUSIONS This is the largest European multicentre study of RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centres with a wide experience in open kidney transplantation and robotic surgery.
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Affiliation(s)
- Mireia Musquera
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
| | - Lluis Peri
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
| | - Tarek Ajami
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Volkan Tugcu
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Michael Stockle
- Department of Urology, University Saarland, Homburg/Saar, Germany
| | - Paolo Fornara
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Frances Vigues
- Department of Urology, Hospital Universitari de Bellvitge, Hospitalet del Llobregat, Spain
| | - Ravi Barod
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Selçuk Sahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | | | - Neal Banga
- Department of Urology, Royal Free London NHS Foundation Trust, London, UK
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic de Barcelona Instituto Clínic de Nefrología y Urología, Barcelona, Spain
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Kauffmann EF, Napoli N, Cacace C, Menonna F, Vistoli F, Amorese G, Boggi U. Resection or repair of large peripancreatic arteries during robotic pancreatectomy. Updates Surg 2020; 72:145-153. [DOI: 10.1007/s13304-020-00715-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Accepted: 01/22/2020] [Indexed: 02/08/2023]
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Tzvetanov IG, Spaggiari M, Tulla KA, Di Bella C, Okoye O, Di Cocco P, Jeon H, Oberholzer J, Cristoforo Giulianotti P, Benedetti E. Robotic kidney transplantation in the obese patient: 10-year experience from a single center. Am J Transplant 2020; 20:430-440. [PMID: 31571369 DOI: 10.1111/ajt.15626] [Citation(s) in RCA: 60] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 09/19/2019] [Accepted: 09/24/2019] [Indexed: 01/25/2023]
Abstract
Despite increasing obesity rates in the dialysis population, obese kidney transplant candidates are still denied transplantation by many centers. We performed a single-center retrospective analysis of a robotic-assisted kidney transplant (RAKT) cohort from January 2009 to December 2018. A total of 239 patients were included in this analysis. The median BMI was 41.4 kg/m2 , with the majority (53.1%) of patients being African American and 69.4% of organs sourced from living donors. The median surgery duration and warm ischemia times were 4.8 hours and 45 minutes respectively. Wound complications (mostly seromas and hematomas) occurred in 3.8% of patients, with 1 patient developing a surgical site infection (SSI). Seventeen (7.1%) graft failures, mostly due to acute rejection, were reported during follow-up. Patient survival was 98% and 95%, whereas graft survival was 98% and 93%, at 1 and 3 years respectively. Similar survival statistics were obtained from patients undergoing open transplant over the same time period from the UNOS database. In conclusion, RAKT can be safely performed in obese patients with minimal SSI risk, excellent graft function, and patient outcomes comparable to national data. RAKT could improve access to kidney transplantation in obese patients due to the low surgical complication rate.
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Affiliation(s)
- Ivo G Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Kiara A Tulla
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Caterina Di Bella
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Obi Okoye
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Hoonbae Jeon
- Department of Surgery, Tulane University, New Orleans, Louisiana
| | - Jose Oberholzer
- Charles O. Strickler Transplant Center, University of Virginia Health System, Charlottesville, Virginia
| | - Pier Cristoforo Giulianotti
- Division of General, Minimally Invasive, & Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, Illinois
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Abstract
BACKGROUND Robot-assisted surgery has become widely adopted in urology due to advantages in comparison with laparoscopic or open approaches. Robot-assisted living kidney transplantation is one of the most challenging procedures in urology regarding technical, but also psychological and ethical aspects, and is currently routinely performed in two German departments. OBJECTIVES The goal was to analyze and compare current evidence and experiences of robot-assisted living kidney transplantation in Europe and in Germany. MATERIALS AND METHODS A systematic search was performed to identify relevant publications. They were compared with latest results from two German academic centers (Halle and Homburg/Saar). RESULTS In 2015, robot-assisted living kidney transplantation was performed for the first time in Europe. Since then, 8 academic centers have established this procedure. Until today, more than 180 robot-assisted kidney transplantations have been performed. Short- and mid-term results have proven to be excellent with low complication rates. Apart from 3 transplant losses because of arterial thrombosis and 5 surgical re-explorations due to hematoma, no other noteworthy complications occurred. There was only 1 lymphocele. The median blood loss was 150 ml and kidney function after 1 year was unchanged in comparison with postoperative day 30. CONCLUSIONS Robot-assisted living kidney transplantation is not inferior to the open approach. Even superiority is not unlikely because problematic situations such as obese patients or complex vascular anatomy can be handled safely. In particular, the development of lymphocele and wound healing disorders appear to be significantly decreased compared to conventional surgery.
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Affiliation(s)
- P Zeuschner
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - S Siemer
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - M Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland.
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Eltemamy M, Garisto J, Miller E, Wee A, Kaouk J. Single Port Robotic Extra-peritoneal Dual Kidney Transplantation: Initial Preclinical Experience and Description of the Technique. Urology 2019; 134:232-236. [DOI: 10.1016/j.urology.2019.09.007] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2019] [Revised: 09/06/2019] [Accepted: 09/06/2019] [Indexed: 01/06/2023]
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Ganpule A, Patil A, Singh A, Desai M, Gill I, Sabnis R, Desai M. Robotic-assisted kidney transplant: a single center experience with median follow-up of 2.8 years. World J Urol 2019; 38:2651-2660. [PMID: 31489478 DOI: 10.1007/s00345-019-02934-0] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2019] [Accepted: 08/28/2019] [Indexed: 12/14/2022] Open
Abstract
PURPOSE The main aim of the paper is to report a single-centre experience with RAKT, focusing on surgical, perioperative and functional outcomes at a median follow-up of 2.8 years. METHODS Data of 26 RAKT patients was prospectively collected from December 2014 to February 2019 with follow-up of up to 55 months. All donors were done laparoscopically. We followed Vattikuti-Medanta technique with modification of using pfannenstiel incision instead of Gelpoint and patient positioned in steep Trendelenburg position (30°) with leg split position. Hypothermia was maintained using a "modified graft hypothermia jacket". The engrafted kidney is oriented with the vessels being tagged with Prolene sutures. RESULTS The mean BMI was 26.1 ± 4.7. The mean warm, cold and total ischemia times were 4.8 ± 1.1, 113.8 ± 20.9 and 118.7 ± 21.2 min, respectively. Mean rewarming time was 62.5 ± 10 min. The mean post-operative day (POD) 1, 3, 7, 30, 6 months, 1 year and most recent creatinine was 3.4, 2.4, 1.8, 1.4,1.2, 1.2 and 1.69 mg/dl. There was no case of delayed graft dysfunction (DGF) with graft survival of 1.8-55 months. The mean GFR at POD 1, 1 month and 1 year was 24, 53.16 and 64.6. We had two intraoperative complications-one topsy turvy graft placement with anastomosis of donor ureter to native ureter and other had to be converted to open technique after anastomosis to control graft surface bleeding. Three postoperative complications-one patient has graft pyelonephritis which was managed conservatively with antibiotics. Two patients had lymphocele. One patient was managed with just aspiration while the other required laparoscopic de-roofing of the lymphocele. The mean hospital stay was 13.5 ± 3 days. CONCLUSIONS RAKT is feasible and safe only if performed by surgeons with appropriate background in robotic surgery and kidney transplantation after proper surgical training at experienced centres in the mid-term follow-up. Further studies need to confirm the long-term safety of RAKT.
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Affiliation(s)
- Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India.
| | - Abhijit Patil
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Abhishek Singh
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mihir Desai
- Department of Urology, Keck Hospital of USC, Los Angeles, USA
| | - Inderbir Gill
- Department of Urology, Keck Hospital of USC, Los Angeles, USA
| | - Ravindra Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
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The Evolution of Kidney Transplantation Surgery Into the Robotic Era and Its Prospects for Obese Recipients. Transplantation 2019; 102:1650-1665. [PMID: 29916987 DOI: 10.1097/tp.0000000000002328] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20th century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means. The different techniques, indications, advantages, disadvantages, and future directions of this approach will be explored in detail. Robot-assisted kidney transplantation may become the preferred means of transplanting morbidly obese recipients, although its availability to such recipients remains extremely limited and strategies targeting weight loss pretransplantation should never be abandoned in favor of a "RAKT-first" approach.
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Territo A, Gausa L, Alcaraz A, Musquera M, Doumerc N, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Sahin S, Tuǧcu V, Basile G, Breda A. European experience of robot-assisted kidney transplantation: minimum of 1-year follow-up. BJU Int 2018; 122:255-262. [PMID: 29645355 DOI: 10.1111/bju.14247] [Citation(s) in RCA: 41] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVES To evaluate functional results, graft survival and late complications in patients who underwent robot-assisted kidney transplantation (RAKT) and who had a minimum of 1 year of follow-up data, and to analyse the correlations between surgical data and functional results at a minimum of 1-year postoperatively and between renal function in the immediate postoperative period and after 1 year. MATERIALS AND METHODS A common prospectively collected RAKT database was created by the European Robotic Urological Section (ERUS) RAKT working group, which included eight different European centres. In each centre RAKTs were performed with kidneys from living donors. Data on demographic variables, surgical results, graft survival, functional outcomes (creatinine and estimated glomerular filtration rate [eGFR]) on postoperative days 7 and 30 and at 1 year, and late complications were extracted from the common database. RESULTS A total of 147 RAKTs were performed by the ERUS RAKT working group. Of the 147 patients, 83 had at least 1-year follow-up (mean [range] 21 [13-27] months). Of these 83 patients, 30 were women. The patients' median (range) age was 43 (30-75) years, body mass index was 25.3 (20-40) kg/m2 , pre-transplantation serum creatinine was 517 (198-1 414) μmol/L and estimated GFR (eGFR) was 10 (3-29) mL/min per 1.73 m2 . Of the 83 cases, 46 were pre-emptive. The median (range) overall ischaemia time was 116 (53-377) min. The median (range) rewarming time was 60 (35-110) min. At 1-year follow-up, the median (range) serum creatinine was 131 (66-244) μmol/L, with a median (range) eGFR of 57.4 (28-97) mL/min per 1.73 m2 . There was no statistically significant difference between functional data at postoperative day 30 and those at 1 year for creatinine (P = 0.78) or eGFR (P = 0.91). Regarding the correlation between the surgical data and the functional outcomes, the data showed that overall operating time and rewarming time did not affect the graft function at 1 year. Three cases of graft loss occurred as a result of massive arterial thrombosis within the first postoperative week. Late complications comprised one case of ureteric stenosis and one case of graft pyelonephritis. No late vascular complications or cases of incisional hernia were recorded. CONCLUSION Findings at 1-year follow-up indicate RAKT from a living donor to be a safe procedure in a properly selected group of recipients. RAKT was associated with a low complication rate and there was maintenance of excellent graft survival and function. This is the first and largest study to report functional results after RAKT from a living donor with a minimum follow-up of 1 year.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Lluis Gausa
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Department of Urology, Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | | | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
| | - Michael Stockle
- Department of Urology, University Saarland, Homburg/Saar, Germany
| | - Martin Janssen
- Department of Urology, University Saarland, Homburg/Saar, Germany
| | - Paolo Fornara
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Nasreldin Mohammed
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Giampaolo Siena
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Selcuk Sahin
- Bakirkoy Sadi Konuk Training and Research Hospital Centre, Istanbul, Turkey
| | - Volkan Tuǧcu
- Bakirkoy Sadi Konuk Training and Research Hospital Centre, Istanbul, Turkey
| | - Giuseppe Basile
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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Robotic kidney autotransplantation in a porcine model: a procedure-specific training platform for the simulation of robotic intracorporeal vascular anastomosis. J Robot Surg 2018; 12:693-698. [PMID: 29605864 DOI: 10.1007/s11701-018-0806-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022]
Abstract
Robotic-assisted kidney transplantation (RKT) with the Da Vinci (Intuitive, USA) platform has been recently developed to improve outcomes by decreasing surgical site complications and morbidity, especially in obese patients. This potential paradigm shift in the surgical technique of kidney transplantation is performed in only a few centers. For wider adoption of this high stake complex operation, we aimed to develop a procedure-specific simulation platform in a porcine model for the training of robotic intracorporeal vascular anastomosis and evaluating vascular anastomoses patency. This paper describes the requirements and steps developed for the above training purpose. Over a series of four animal ethics' approved experiments, the technique of robotic-assisted laparoscopic autotransplantation of the kidney was developed in Amsterdam live pigs (60-70 kg). The surgery was based around the vascular anastomosis technique described by Menon et al. This non-survival porcine training model is targeted at transplant surgeons with robotic surgery experience. Under general anesthesia, each pig was placed in lateral decubitus position with the placement of one robotic camera port, two robotic 8 mm ports and one assistant port. Robotic docking over the pig posteriorly was performed. The training platform involved the following procedural steps. First, ipsilateral iliac vessel dissection was performed. Second, robotic-assisted laparoscopic donor nephrectomy was performed with in situ perfusion of the kidney with cold Hartmann's solution prior to complete division of the hilar vessels, ureter and kidney mobilization. Thirdly, the kidney was either kept in situ for orthotopic autotransplantation or mobilized to the pelvis and orientated for the vascular anastomosis, which was performed end to end or end to side after vessel loop clamping of the iliac vessels, respectively, using 6/0 Gore-Tex sutures. Following autotransplantation and release of vessel loops, perfusion of the graft was assessed using intraoperative indocyanine green imaging and monitoring urine output after unclamping. This training platform demonstrates adequate face and content validity. With practice, arterial anastomotic time could be improved, showing its construct validity. This porcine training model can be useful in providing training for robotic intracorporeal vascular anastomosis and may facilitate confident translation into a transplant human recipient.
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Stiegler P, Schemmer P. Robot-Assisted Transplant Surgery - Vision or Reality? A Comprehensive Review. Visc Med 2018; 34:24-30. [PMID: 29594166 PMCID: PMC5869533 DOI: 10.1159/000485686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Minimally invasive surgery is standard procedure for many operations. Further refinements include the introduction of robotic surgery which is still an emerging field especially in laparoscopic surgery. Since the successful introduction of the da Vinci Robotic Surgical System, the robotic approach in organ transplantation has become of great interest in both the live donor organ retrieval and the recipient operation. Robotic surgery for kidney, liver, and pancreas transplantation is feasible. Over 700 donor nephrectomies and 100 kidney transplantations have been performed already, and robotic surgery is standard in a small number of pioneer centers; however, larger series and most importantly randomized controlled trials for the highest evidence are needed. Longer warm ischemia time and higher costs limit these procedures at the moment.
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Affiliation(s)
- Philipp Stiegler
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Transplant Center Graz, Medical University of Graz, Graz, Austria
| | - Peter Schemmer
- Division of Transplant Surgery, Department of Surgery, Medical University of Graz, Graz, Austria
- Transplant Center Graz, Medical University of Graz, Graz, Austria
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30
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Breda A, Territo A, Gausa L, Tuğcu V, Alcaraz A, Musquera M, Decaestecker K, Desender L, Stockle M, Janssen M, Fornara P, Mohammed N, Siena G, Serni S, Guirado L, Facundo C, Doumerc N. Robot-assisted Kidney Transplantation: The European Experience. Eur Urol 2018; 73:273-281. [DOI: 10.1016/j.eururo.2017.08.028] [Citation(s) in RCA: 60] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 08/27/2017] [Indexed: 01/13/2023]
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31
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Meier RPH, Piller V, Hagen ME, Joliat C, Buchs J, Nastasi A, Ruttimann R, Buchs NC, Moll S, Vallée J, Lazeyras F, Morel P, Bühler L. Intra-Abdominal Cooling System Limits Ischemia-Reperfusion Injury During Robot-Assisted Renal Transplantation. Am J Transplant 2018; 18:53-62. [PMID: 28637093 PMCID: PMC5763420 DOI: 10.1111/ajt.14399] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2017] [Revised: 06/04/2017] [Accepted: 06/14/2017] [Indexed: 01/25/2023]
Abstract
Robot-assisted kidney transplantation is feasible; however, concerns have been raised about possible increases in warm ischemia times. We describe a novel intra-abdominal cooling system to continuously cool the kidney during the procedure. Porcine kidneys were procured by standard open technique. Groups were as follows: Robotic renal transplantation with (n = 11) and without (n = 6) continuous intra-abdominal cooling and conventional open technique with intermittent 4°C saline cooling (n = 6). Renal cortex temperature, magnetic resonance imaging, and histology were analyzed. Robotic renal transplantation required a longer anastomosis time, either with or without the cooling system, compared to the open approach (70.4 ± 17.7 min and 74.0 ± 21.5 min vs. 48.7 ± 11.2 min, p-values < 0.05). The temperature was lower in the robotic group with cooling system compared to the open approach group (6.5 ± 3.1°C vs. 22.5 ± 6.5°C; p = 0.001) or compared to the robotic group without the cooling system (28.7 ± 3.3°C; p < 0.001). Magnetic resonance imaging parenchymal heterogeneities and histologic ischemia-reperfusion lesions were more severe in the robotic group without cooling than in the cooled (open and robotic) groups. Robot-assisted kidney transplantation prolongs the warm ischemia time of the donor kidney. We developed a novel intra-abdominal cooling system that suppresses the noncontrolled rewarming of donor kidneys during the transplant procedure and prevents ischemia-reperfusion injuries.
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Affiliation(s)
- R. P. H. Meier
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - V. Piller
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - M. E. Hagen
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - C. Joliat
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - J.‐B. Buchs
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - A. Nastasi
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - R. Ruttimann
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - N. C. Buchs
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - S. Moll
- Division of Clinical PathologyDepartment of Pathology and ImmunologyGeneva University Hospital and Medical SchoolGenevaSwitzerland
| | - J.‐P. Vallée
- Department of Radiology and Medical InformaticsFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - F. Lazeyras
- Department of Radiology and Medical InformaticsFaculty of MedicineUniversity of GenevaGenevaSwitzerland
| | - P. Morel
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
| | - L. Bühler
- Visceral and Transplant SurgeryDepartment of SurgeryGeneva University Hospitals and Medical SchoolGenevaSwitzerland
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Tuğcu V, Şener NC, Şahin S, Yavuzsan AH, Akbay FG, Apaydın S. Robot-assisted kidney transplantation: comparison of the first 40 cases of open vs robot-assisted transplantations by a single surgeon. BJU Int 2017; 121:275-280. [DOI: 10.1111/bju.14014] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023]
Affiliation(s)
- Volkan Tuğcu
- Department of Urology; Bakirkoy Dr Sadi Konuk Teaching and Research Hospital; Istanbul Turkey
| | - Nevzat Can Şener
- Department of Urology; Bakirkoy Dr Sadi Konuk Teaching and Research Hospital; Istanbul Turkey
| | - Selçuk Şahin
- Department of Urology; Bakirkoy Dr Sadi Konuk Teaching and Research Hospital; Istanbul Turkey
| | - Abdullah H. Yavuzsan
- Department of Urology; Bakirkoy Dr Sadi Konuk Teaching and Research Hospital; Istanbul Turkey
| | - Fatih G. Akbay
- Department of Nephrology; Bakirkoy Dr Sadi Konuk Teaching and Research Hospital; Istanbul Turkey
| | - Süheyla Apaydın
- Department of Nephrology; Bakirkoy Dr Sadi Konuk Teaching and Research Hospital; Istanbul Turkey
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33
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The Gift of Life: New Opportunities from Renal Transplantation. Eur Urol 2017; 73:282-283. [PMID: 28988752 DOI: 10.1016/j.eururo.2017.09.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2017] [Accepted: 09/19/2017] [Indexed: 11/20/2022]
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34
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Uwechue R, Chandak P, Ahmed Z, Gogalniceanu P, Kessaris N, Mamode N. Minimally invasive surgical techniques for kidney transplantation. Hippokratia 2017. [DOI: 10.1002/14651858.cd012698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Raphael Uwechue
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Pankaj Chandak
- Department of Transplant Surgery; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Zubir Ahmed
- General and Transplant Surgery; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Petrut Gogalniceanu
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Nicos Kessaris
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
| | - Nizam Mamode
- Department of Transplantation; Guy's and St Thomas' NHS Foundation Trust; London UK
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Wagenaar S, Nederhoed JH, Hoksbergen AWJ, Bonjer HJ, Wisselink W, van Ramshorst GH. Minimally Invasive, Laparoscopic, and Robotic-assisted Techniques Versus Open Techniques for Kidney Transplant Recipients: A Systematic Review. Eur Urol 2017; 72:205-217. [PMID: 28262412 DOI: 10.1016/j.eururo.2017.02.020] [Citation(s) in RCA: 66] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Accepted: 02/09/2017] [Indexed: 12/14/2022]
Abstract
CONTEXT Literature on conventional and minimally invasive operative techniques has not been systematically reviewed for kidney transplant recipients. OBJECTIVE To systematically evaluate, summarize, and review evidence supporting operating technique and postoperative outcome for kidney transplant recipients. EVIDENCE ACQUISITION A systematic review was conducted in PubMed-Medline, Embase, and Cochrane Library between 1966 up to September 1, 2016, according to Preferred Reporting Items for Systematic Review and Meta-analysis guidelines. Articles were included and scored by two independent reviewers using Group Reading Assessment and Diagnostic Evaluation (GRADE), Newcastle-Ottawa Quality Assessment Scale (NOS), and Oxford guidelines for level of evidence. Main outcomes were graft survival, surgical site infection, incisional hernia, and cosmetic result. In total, 18 out of 1954 identified publications were included in this analysis. EVIDENCE SYNTHESIS Included reports described conventional open, minimally invasive open, laparoscopic, and robotic-assisted techniques. General level of evidence of included studies was low (GRADE: 1-3; NOS: 0-4; and Oxford level of evidence: 4-2). No differences in graft or patient survival were found. For open techniques, Gibson incision showed better results than the hockey-stick incision for incisional hernia (4% vs 16%), abdominal wall relaxation (8% vs 24%), and cosmesis. Minimally invasive operative recipient techniques showed lowest surgical site infection (range 0-8%) and incisional hernia rates (range 0-6%) with improved cosmetic result and postoperative recovery. Disadvantages included prolonged cold ischemia time, warm ischemia time, and total operation time. CONCLUSIONS Although the level of evidence was generally low, minimally invasive techniques showed promising results with regard to complications and recovery, and could be considered for use. For open surgery, the smallest possible Gibson incision appeared to yield favorable results. PATIENT SUMMARY In this paper, the available evidence for minimally invasive operation techniques for kidney transplantation was reviewed. The quality of the reviewed research was generally low but suggested possible advantages for minimally invasive, laparoscopic, and robot-assisted techniques.
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Affiliation(s)
- Sven Wagenaar
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Urology, Meander Medical Centre, Amersfoort, The Netherlands.
| | | | | | - H Jaap Bonjer
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Willem Wisselink
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands
| | - Gabrielle H van Ramshorst
- Department of Surgery, VU Medical Center, Amsterdam, The Netherlands; Department of Surgery, Dutch Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands
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Robotic kidney transplantation: one year after the beginning. World J Urol 2017; 35:1507-1515. [PMID: 28229210 DOI: 10.1007/s00345-017-2006-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2016] [Accepted: 01/11/2017] [Indexed: 10/20/2022] Open
Abstract
INTRODUCTION Kidney transplantation (KT) is the preferred treatment for patients with end-stage renal disease (ESRD). To reduce the morbidity of the open surgery, a robotic-assisted approach has been recently introduced. Our aim is to evaluate surgical and functional results on 17 cases of robotic-assisted kidney transplantation (RAKT) performed at the same institution. MATERIALS AND METHODS From July 2015 to June 2016, we performed 17 cases of RAKT from living donors in pre-emptive patients, who underwent laparoscopic nephrectomy. A prospective pilot study was made at Fundació Puigvert (Barcelona), evaluating functional and surgical outcomes. In this series, we considered the functional results, surgical outcomes and complications rates. RESULTS Seventeen patients successfully underwent RAKT, in particular surgical console time was 181 min (150-200) with vascular suture time 42 min (32-48), and estimated blood loss <70 ml. Overall ischemia time was 98.9 min (84-140). No patient was converted to open transplantation. No major surgical intra-operative complications were observed. The mean post-operative serum creatinine level 160 μmol/L (81-479). We reported a case of delayed graft function (DGF), one case of graft arterial thrombosis and one case of intraperitoneal hematoma. No anastomosis revision and wounds infections occurred. CONCLUSION RAKT with regional hypothermia appears to be a safe surgical procedure in a properly selected group of patients. The potential advantages of RAKT are related to the quality of the vascular anastomosis, the possible lower complication rate and the shorter recovery of the recipients.
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Levi Sandri GB, de Werra E, Mascianà G, Guerra F, Spoletini G, Lai Q. The use of robotic surgery in abdominal organ transplantation: A literature review. Clin Transplant 2017; 31. [PMID: 27726195 DOI: 10.1111/ctr.12856] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Abstract
Minimally invasive surgical approaches in transplantation are gaining increasing interest, and many centers are reporting their, mainly laparoscopic, experiences. Robotic surgery (RS) has some hypothetical advantages over traditional laparoscopy and has been successfully applied, although infrequently to organ transplantation. Our goal was to review and critique the publications reporting RS use in organ transplantation. Most of the RS experience has been with living renal donor organ procurement and, to a lesser extent, with RS procedures in the transplant recipient. The available literature suggests that RS appears to be a safe surgical alternative to standard open procedures. RS in living liver donor surgery remains limited, and more experience is required before commenting on RS-related outcomes RS in pancreatic transplantation is exceedingly rare. The enhanced precision and ergonomics of RS may expand its applicability to liver living donation and pancreas transplantation at some point in the future.
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Affiliation(s)
- Giovanni B Levi Sandri
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
- Department of Surgical Sciences, Sapienza University of Rome, Rome, Italy
| | - Edoardo de Werra
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
| | - Gianluca Mascianà
- Division of General Surgery and Liver Transplantation, San Camillo Hospital, Rome, Italy
| | - Francesco Guerra
- Division of Oncological and Robotic General Surgery, Careggi University Hospital, Florence, Italy
| | - Gabriele Spoletini
- Department of HPB and Liver Transplant Surgery, Royal Free Hospital, London, UK
| | - Quirino Lai
- Transplant Unit, Department of Surgery, University of L'Aquila, San Salvatore Hospital, L'Aquila, Italy
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Kauffmann EF, Napoli N, Menonna F, Vistoli F, Amorese G, Campani D, Pollina LE, Funel N, Cappelli C, Caramella D, Boggi U. Robotic pancreatoduodenectomy with vascular resection. Langenbecks Arch Surg 2016; 401:1111-1122. [PMID: 27553112 DOI: 10.1007/s00423-016-1499-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2016] [Accepted: 08/11/2016] [Indexed: 12/16/2022]
Abstract
PURPOSE This study aims to define the current status of robotic pancreatoduodenectomy (RPD) with resection and reconstruction of the superior mesenteric/portal vein (RPD-SMV/PV). METHODS Our experience on RPD, including RPD-SMV/PV, is presented along with a description of the surgical technique and a systematic review of the literature on RPD-SMV/PV. RESULTS We have performed 116 RPD and 14 RPD-SMV/PV. Seven additional cases of RPD-SMV/PV were identified in the literature. In our experience, RPD and RPD-SMV/PV were similar in all baseline variables, but lower mean body mass and higher prevalence of pancreatic cancer in RPD-SMV/PV. Regarding the type of vein resection, there were one type 2 (7.1 %), five type 3 (35.7 %) and eight type 4 (57.2 %) resections. As compared to RPD, RPD-SMV/PV required longer operative time, had higher median estimated blood loss, and blood transfusions were required more frequently. Incidence and severity of post-operative complications were not increased in RPD-SMV/PV, but post-pancreatectomy hemorrhage occurred more frequently after this procedure. In pancreatic cancer, RPD-SMV/PV was associated with a higher mean number of examined lymph nodes (60.0 ± 13.9 vs 44.6 ± 11.0; p = 0.02) and with the same rate of microscopic margin positivity (25.0 % vs 26.1 %). Mean length or resected vein was 23.1 ± 8.08 mm. Actual tumour infiltration was discovered in ten patients (71.4 %), reaching the adventitia in four patients (40.0 %), the media in two patients (20.0 %), and the intima in four patients (40.0 %). Literature review identified seven additional cases, all reported to have successful outcome. CONCLUSIONS RPD-SMV/PV is feasible in carefully selected patients. The generalization of these results remains to be demonstrated.
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Affiliation(s)
- Emanuele F Kauffmann
- Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Niccolò Napoli
- Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Francesca Menonna
- Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Fabio Vistoli
- Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy
| | - Gabriella Amorese
- Division of Anesthesia and Intensive Care, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Daniela Campani
- Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Luca Emanuele Pollina
- Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Niccola Funel
- Division of Pathology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Carla Cappelli
- Division of Radiology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Davide Caramella
- Division of Radiology, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Pisa, Italy
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa and Azienda Ospedaliero Universitaria Pisana, Via Paradisa 2, 56124, Pisa, Italy.
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La transplantation rénale et ses défis. Prog Urol 2016; 26:1001-1044. [PMID: 27720627 DOI: 10.1016/j.purol.2016.09.056] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2016] [Accepted: 09/12/2016] [Indexed: 01/09/2023]
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Nowacki M, Nazarewski Ł, Kloskowski T, Tyloch D, Pokrywczyńska M, Pietkun K, Jundziłł A, Tyloch J, Habib SL, Drewa T. Novel surgical techniques, regenerative medicine, tissue engineering and innovative immunosuppression in kidney transplantation. Arch Med Sci 2016; 12:1158-1173. [PMID: 27695507 PMCID: PMC5016594 DOI: 10.5114/aoms.2016.61919] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/01/2014] [Accepted: 02/08/2015] [Indexed: 01/09/2023] Open
Abstract
On the 60th anniversary of the first successfully performed renal transplantation, we summarize the historical, current and potential future status of kidney transplantation. We discuss three different aspects with a potential significant influence on kidney transplantation progress: the development of surgical techniques, the influence of regenerative medicine and tissue engineering, and changes in immunosuppression. We evaluate the standard open surgical procedures with modern techniques and compare them to less invasive videoscopic as well as robotic techniques. The role of tissue engineering and regenerative medicine as a potential method for future kidney regeneration or replacement and the interesting search for novel solutions in the field of immunosuppression will be discussed. After 60 years since the first successfully performed kidney transplantation, we can conclude that the greatest achievements are associated with the development of surgical techniques and with planned systemic immunosuppression.
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Affiliation(s)
- Maciej Nowacki
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Chair of Surgical Oncology, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Łukasz Nazarewski
- Department of General, Transplant and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Tomasz Kloskowski
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Dominik Tyloch
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Marta Pokrywczyńska
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Katarzyna Pietkun
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Arkadiusz Jundziłł
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Janusz Tyloch
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
| | - Samy L. Habib
- Department of Geriatrics, Geriatric Research, Education, and Clinical Center, South Texas Veterans Healthcare System, San Antonio, TX, USA
- Department of Cellular and Structural Biology, University of Texas Health Science Center, San Antonio, TX, USA
| | - Tomasz Drewa
- Chair of Urology, Department of Regenerative Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Torun, Poland
- Department of General and Oncological Urology, Nicolaus Copernicus Hospital, Torun, Poland
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Indications, technique, and results of robotic pancreatoduodenectomy. Updates Surg 2016; 68:295-305. [DOI: 10.1007/s13304-016-0387-7] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 08/11/2016] [Indexed: 12/12/2022]
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Abstract
Robotic surgery has enabled surgeons to offer more patients a minimally invasive surgical option in the management of their complex diseases. While renal transplantation is associated with significant improvements in quantity and quality of life for most end-stage renal disease (ESRD) patients, it is also not devoid of its surgical risks and potential morbidities. Robotic-assisted kidney transplantation is a recently described, innovative application of the robotic surgery platform, and early experiences suggest that it is associated with comparable graft function and lower rates of complications. Urinary tract obstruction, though less common than ESRD, can be a serious threat to renal function. Severe ureteric stricture disease can represent a clinically complex problem requiring major reconstructive surgery. Completely intra-corporeal robotic renal auto-transplantation is another innovative application of the robotic surgery platform and represents a significant advancement in urologic surgery. Initial reports of this procedure demonstrate safety, feasibility, and excellent renal function outcomes.
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Affiliation(s)
- Jason Lee
- Department of Surgery, University of Toronto, Toronto, M5C2T2, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, M5B 1W8, Canada
| | - Michael Ordon
- Department of Surgery, University of Toronto, Toronto, M5C2T2, Canada; Li Ka Shing Knowledge Institute, St Michael's Hospital, Toronto, M5B 1W8, Canada
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Sood A, McCulloch P, Dahm P, Ahlawat R, Jeong W, Bhandari M, Menon M. Ontogeny of a surgical technique: Robotic kidney transplantation with regional hypothermia. Int J Surg 2015; 25:158-61. [PMID: 26718609 DOI: 10.1016/j.ijsu.2015.12.061] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Revised: 12/13/2015] [Accepted: 12/17/2015] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Innovation is a hallmark of surgical practice. It is generally accepted that a new procedure will undergo technical changes during its evolution; however, quantitative accounts of the process are limited. METHODS Multiple groups, including our own, have recently described a minimally-invasive approach to conventional kidney transplantation (KT) operation. Unique to our experience is a structured development of the technique within the confines of a safe surgical innovation framework - the IDEAL framework (idea, development, exploration, assessment, long-term monitoring; stages 0-4). We here provide a first-hand narrative of the progress of robotic KT operation from preclinical trial to clinical application. RESULTS Overall, 54 patients underwent robotic KT with regional hypothermia successfully. Major technical changes including selection of optimal patient position (flank vs. lithotomy), robotic instrumentation, vascular occlusion method (bulldog vs. tourniquet) and suture material (prolene vs. GoreTex) occurred early during the procedure development (IDEAL stage 0, preclinical). Minor technical changes such as utilization of the aortic punch for arteriotomy (case 3), use of barbed suture during ureteroneocystostomy (case 6) and extraperitonealization of the graft kidney (case 6) that increased the efficiency and safety of the procedure continued throughout procedure development (IDEAL stages 1-2, clinical stages). CONCLUSIONS We demonstrate that a surgical technique evolves continually; although, the majority of technical alterations occur early in the life-cycle of the procedure. Development of a new technique within the confines a structured surgical innovation framework allows for evidence based progression of the technique and may minimize the risk of harm to the patient.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA.
| | - Peter McCulloch
- Nuffield Department of Surgery, University of Oxford, Oxford, UK
| | - Philipp Dahm
- Department of Urology, University of Minnesota, Minneapolis, MN, USA
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta - The Medicity, Gurgaon, India
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | | | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
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First Robotic-Assisted Dual Kidney Transplant: Surgical Technique and Report of a Case With 24-month Follow-up. Transplant Direct 2015; 1:e34. [PMID: 27500234 PMCID: PMC4946483 DOI: 10.1097/txd.0000000000000547] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2015] [Accepted: 09/09/2015] [Indexed: 11/25/2022] Open
Abstract
Background Open surgery is the gold standard procedure for kidney transplantation. There is a strong rationale for using minimally invasive surgery in patients with end-stage renal disease. A robotic-assisted dual kidney transplant was performed for the first time at our institution. Methods In August 2013, a 63-year-old man with end-stage renal disease and diabetes mellitus under pharmacological control received both kidneys from a 70-year-old marginal donor. Pretransplant donor biopsy demonstrated a bilateral Karpinski score greater than 5. The organs did not exhibit malformations and each had an artery and a vein. The procedure was carried out by a 7-port intraperitoneal approach using the da Vinci surgical system. The procedure was identical for the 2 kidneys except that mobilization of the sigmoid colon was required to introduce the left graft. The renal vessels were anastomosed to the left external iliac vessels. The novel aspect of the technique was the introduction of both grafts through a single, 7-cm upper midline incision. Results Total operative time was 400 minutes and blood loss was 120 mL. Both grafts immediately began functioning. There were no intraoperative or postoperative complications. The patient was discharged on the seventh postoperative day with normal renal function. At 24 months, he is well and does not require hemodialysis. Conclusions Minimally invasive robotic-assisted technology is a promising technique that provides exceptional patient outcomes by reducing operative morbidity, immobilization, and time to recovery, while affording better esthetic results. Selected patients with multiple comorbidities benefit most. Grafts from marginal donors are an extremely valuable resource.
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Breda A, Gausa L, Territo A, López-Martínez JM, Rodríguez-Faba O, Caffaratti J, de León JP, Guirado L, Villavicencio H. Robotic-assisted kidney transplantation: our first case. World J Urol 2015; 34:443-7. [DOI: 10.1007/s00345-015-1673-6] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2015] [Accepted: 08/18/2015] [Indexed: 11/30/2022] Open
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Modi P, Pal B, Kumar S, Modi J, Saifee Y, Nagraj R, Qadri J, Sharmah A, Agrawal R, Modi M, Shah V, Kute V, Trivedi H. Laparoscopic Transplantation Following Transvaginal Insertion of the Kidney: Description of Technique and Outcome. Am J Transplant 2015; 15:1915-1922. [PMID: 25809421 DOI: 10.1111/ajt.13224] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 01/15/2015] [Accepted: 01/16/2015] [Indexed: 01/25/2023]
Abstract
Laparoscopic kidney transplantation (LKT) is well accepted modality of treatment for ESRD patients at our center. Usually, the kidney is inserted through small Pfannenstiel incision. With the permission of the Internal Review Board, we carried out LKT in eight female recipients following insertion of the kidney through the vagina. The kidney was procured by the retroperitoneoscopic approach. Antibiotic prophylaxis was given. All cases were carried out successfully with immediate graft function and 100% graft and patient survival at 1 year of follow-up. Estimated glomerular filtration rate at 1 month and 1 year was similar to eight randomly selected female recipients who underwent open kidney transplantation (OKT). No analgesia was required in seven out of eight patients after the 3rd postoperative day. In summary, vaginal insertion of kidney and LKT is safe and feasible in a selected group of patients. It is associated with better analgesia and has similar allograft function as compare to OKT.
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Affiliation(s)
- P Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - B Pal
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - S Kumar
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J Modi
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - Y Saifee
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - R Nagraj
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - J Qadri
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - A Sharmah
- Department of Urology and Transplantation Surgery, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - R Agrawal
- Department of Obstetrics and Gynecology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - M Modi
- Department of Anesthesiology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - V Shah
- Department of Anesthesiology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - V Kute
- Department of Nephrology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
| | - H Trivedi
- Department of Nephrology, Smt. G R Doshi and Smt. K M Mehta Institute of Kidney Diseases and Research Centre, Dr H L Trivedi Institute of Transplantation Sciences, Ahmedabad, Gujarat, India
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Sood A, Jeong W, Ahlawat R, Abdollah F, Sammon JD, Bhandari M, Menon M. Minimally invasive renal autotransplantation. J Surg Oncol 2015; 112:717-22. [PMID: 25995142 DOI: 10.1002/jso.23939] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 04/30/2015] [Indexed: 12/11/2022]
Abstract
Minimally invasive renal allotransplantation techniques have been recently described; reported benefits include reduced morbidity/complications. These benefits have been successfully adapted for minimally invasive renal autotransplantation, however, in a non-oncological setting. We, here, describe a novel alternative robot-assisted renal autotransplantation technique, utilizing GelPOINT, which by permitting ex vivo graft examination and surgery might allow further broadening of indications for minimally-invasive renal autotransplantation, to include complex oncological renal/ureteral lesions. Future studies are needed to evaluate the utility of these techniques.
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Affiliation(s)
- Akshay Sood
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Rajesh Ahlawat
- Kidney and Urology Institute, Medanta-The Medicity, Gurgaon, India
| | - Firas Abdollah
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Jesse D Sammon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mahendra Bhandari
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
| | - Mani Menon
- Vattikuti Urology Institute, Henry Ford Health System, Detroit, Michigan
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Tzvetanov I, D'Amico G, Benedetti E. Robotic-assisted Kidney Transplantation: Our Experience and Literature Review. CURRENT TRANSPLANTATION REPORTS 2015; 2:122-126. [PMID: 26000230 PMCID: PMC4431703 DOI: 10.1007/s40472-015-0051-z] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Kidney transplantation is the preferred treatment for patients with end-stage renal disease. While open surgery remains the gold standard, minimally invasive surgery has recently been introduced for the recipient undergoing kidney transplantation. Our team has employed the robotic surgical system to perform renal transplantation in obese recipients to minimize the risk of surgical site infections, with good results in terms of complications and graft and patient survival. However, others groups have performed kidney transplantation robotically in nonobese patients using different techniques. The da Vinci surgical system allows the performance of kidney transplantation under optimal operative conditions. Larger studies and long-term follow-up of recipients are required to determine the effectiveness of this approach. In this article, we describe our experience and review the development of the robotic-assisted kidney transplantation (RAKT).
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Affiliation(s)
- Ivo Tzvetanov
- Division of Transplantation, University of Illinois Hospital & Health Sciences System, Chicago, IL USA ; Department of Surgery, University of Illinois Hospital & Health Sciences System, 840 South Wood Street Suite 402, Chicago, IL 60612 USA
| | - Giuseppe D'Amico
- Division of Transplantation, University of Illinois Hospital & Health Sciences System, Chicago, IL USA
| | - Enrico Benedetti
- Division of Transplantation, University of Illinois Hospital & Health Sciences System, Chicago, IL USA ; Department of Surgery, University of Illinois Hospital & Health Sciences System, 840 South Wood Street Suite 402, Chicago, IL 60612 USA
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Robotic general surgery: current practice, evidence, and perspective. Langenbecks Arch Surg 2015; 400:283-92. [PMID: 25854502 DOI: 10.1007/s00423-015-1278-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2015] [Accepted: 01/27/2015] [Indexed: 12/20/2022]
Abstract
BACKGROUND Robotic technology commenced to be adopted for the field of general surgery in the 1990s. Since then, the da Vinci surgical system (Intuitive Surgical Inc, Sunnyvale, CA, USA) has remained by far the most commonly used system in this domain. The da Vinci surgical system is a master-slave machine that offers three-dimensional vision, articulated instruments with seven degrees of freedom, and additional software features such as motion scaling and tremor filtration. The specific design allows hand-eye alignment with intuitive control of the minimally invasive instruments. As such, robotic surgery appears technologically superior when compared with laparoscopy by overcoming some of the technical limitations that are imposed on the surgeon by the conventional approach. PURPOSE This article reviews the current literature and the perspective of robotic general surgery. CONCLUSIONS While robotics has been applied to a wide range of general surgery procedures, its precise role in this field remains a subject of further research. Until now, only limited clinical evidence that could establish the use of robotics as the gold standard for procedures of general surgery has been created. While surgical robotics is still in its infancy with multiple novel systems currently under development and clinical trials in progress, the opportunities for this technology appear endless, and robotics should have a lasting impact to the field of general surgery.
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Sood A, Ghosh P, Jeong W, Khanna S, Das J, Bhandari M, Kher V, Ahlawat R, Menon M. Minimally invasive kidney transplantation: perioperative considerations and key 6-month outcomes. Transplantation 2015; 99:316-323. [PMID: 25606784 DOI: 10.1097/tp.0000000000000590] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Minimally invasive approaches to kidney transplantation (KT) have been described recently. However, information concerning perioperative management in these patients is lacking. Accordingly, in the current study, we describe our perioperative management strategy in patients undergoing robotic KT with regional hypothermia and report its safety and efficacy. Further, we describe key 6-month outcomes in these patients. METHODS Sixty-seven consecutive end-stage renal disease patients underwent live-donor robotic KT at a single tertiary care institution between January 2013 and June 2014. Outcomes including patient/graft survival, graft function, operative parameters, and perioperative complications are reported in patients with a minimum of 6-month follow-up (n=54). RESULTS All patients successfully underwent robotic KT with regional hypothermia using a modified intraoperative management protocol. None of the cases required conversion to open surgery (0%). Mean console, warm ischemia, and rewarming times were 130.8 minutes, 2.3 minutes and 42.9 minutes, respectively. Mean graft-surface temperature was 19.2°C with zero incidence of systemic hypothermia. Routine extraperitonealization of the graft insured against graft-torsion (0%) despite a transperitoneal approach to graft placement. There were no instances of graft vascular thromboses/stenoses/leaks (0%). Three patients (5.6%) developed clinical head-neck edema but were successfully extubated on table. There was no delayed graft function (0%). Mean 6-month serum creatinine was 1.2 mg/dL. Patient survival was 96.3% (n=52), and death-censored graft survival was 100% at a median follow-up of 13.4 months. CONCLUSIONS Significant differences exist in intraoperative management of patients undergoing robotic KT and open KT. By tweaking fluid infusion rates and pneumatic pressures and maintaining core body temperature, optimal patient outcomes can be achieved. Pretransplant and posttransplant management is essentially the same.
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Affiliation(s)
- Akshay Sood
- 1 Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI. 2 Kidney and Urology Institute, Medanta, Medicity, Gurgaon, India. 3 Department of Anesthesiology, Medanta, Medicity, Gurgaon, India
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