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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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2
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Wang W, Zhuang M, Tao B, Wang F, Wu Y. Learning curve of dynamic navigation-assisted zygomatic implant surgery: An in vitro study. J Prosthet Dent 2024; 132:178.e1-178.e12. [PMID: 38609763 DOI: 10.1016/j.prosdent.2024.03.037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 03/23/2024] [Accepted: 03/26/2024] [Indexed: 04/14/2024]
Abstract
STATEMENT OF PROBLEM Dynamic computer-assisted zygomatic implant surgery (dCAZIS) has been reported to provide clinical efficacy with high accuracy and low risk of complications. However, the learning curve before performing dCAZIS effectively is unknown. PURPOSE The purpose of this in vitro study was to explore the learning curve of dCAZIS in dentists with different levels of experience in implant dentistry and navigation surgery. MATERIAL AND METHODS Six senior dental students were randomly divided into 3 groups for initial training (FH-CI group: pretraining on freehand conventional implant surgery; FH-ZI group: pretraining on freehand ZI surgery; DN-CI group: pretraining on conventional implant surgery under dynamic navigation). Then, every operator conducted 6 repeated dCAZIS training sessions on edentulous 3-dimensional (3D) printed skull models and was asked to complete a self-report questionnaire after each training session. A total of 36 postoperative cone beam computed tomography (CBCT) scans with 144 ZI osteotomy site preparations were obtained and superimposed over the preoperative design for accuracy measurements. The operation time, 3D deviations, and results of the self-reports were recorded. Comparisons among groups were analyzed with independent-sample Kruskal-Wallis tests (α=.05), and correlations between study outcomes and the number of practices were calculated. RESULTS Operator experience and increased practice times did not significantly affect the accuracy of dCAZIS (P>.05). However, the operation time varied among groups (P<.001), and significantly shortened with more practice, reaching 11.51 ±1.68 minutes at the fifth attempt in the FH-CI group (P<.001 compared with the first practice), 14.48 ±3.07 minutes at the third attempt in the FH-ZI group (P=.038), and 8.68 ±0.58 minutes at the sixth attempt in the DN-CI group (P<.001). All groups reached their own learning curve plateau stage within 6 practice sessions. As the number of practice sessions increased, the results from the self-report questionnaires gradually improved. CONCLUSIONS Among dentists with different levels of experience in implant dentistry and navigation surgery, dCAZIS was found to have a learning curve with respect to operation time but not implant accuracy. Experience in ZI surgery had little impact on the learning curve of dCAZIS, but experience in navigation surgery was a key factor.
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Affiliation(s)
- Wenying Wang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Minjie Zhuang
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Baoxin Tao
- Graduate student, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Feng Wang
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China
| | - Yiqun Wu
- Professor, Second Dental Center, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, College of Stomatology, Shanghai Jiao Tong University, National Center for Stomatology, National Clinical Research Center for Oral Diseases, Shanghai Key Laboratory of Stomatology, Shanghai Research Institute of Stomatology, Shanghai, PR China.
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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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Malinzak L, Gartrelle K, Sragi Z, Segal A, Prashar R, Jesse MT. Access to robotic assisted kidney transplant for recipients: a systematic review and call for reporting standards. J Robot Surg 2024; 18:239. [PMID: 38833043 DOI: 10.1007/s11701-024-01927-5] [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: 03/12/2024] [Accepted: 03/24/2024] [Indexed: 06/06/2024]
Abstract
Robot-assisted kidney transplantation (RAKT) is a relatively novel, minimally invasive option for kidney transplantation. However, clarity on recipient selection in the published literature is lacking thereby significantly limiting interpretation of safety and other outcomes. This systematic review aimed to identify and synthesize the data on selection of RAKT recipients, compare the synthesized data to kidney transplant recipients across the USA, and explore geographical clusters of availability of RAKT. Systematic literature review, in accordance with PRISMA, via OVID MEDLINE, Embase, and Web of science from inception to March 5, 2023. All data entry double blinded and quality via Newcastle Ottawa Scale. 44 full-text articles included, encompassing approximately 2402 kidney transplant recipients at baseline but with considerable suspicion for overlap across publications. There were significant omissions of information across studies on patient selection for RAKT and/or analysis. Overall, the quality of studies was very low. Given suspicion of overlap across studies, it is difficult to determine how many RAKT recipients received living (LD) versus deceased donor (DD) organs, but a rough estimate suggests 89% received LD. While the current RAKT literature provides preliminary evidence on safety, there are significant omissions in reporting on patient selection for RAKT which limits interpretation of findings. Two recommendations: (1) international consensus is needed for reporting guidelines when publishing RAKT data and (2) larger controlled trials consistently reporting recipient characteristics are needed to clearly determine selection, safety, and outcomes across both LD and DD recipients.
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Affiliation(s)
- Lauren Malinzak
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA.
| | - Kendyll Gartrelle
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Zara Sragi
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Antu Segal
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Rohini Prashar
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
| | - Michelle T Jesse
- Henry Ford Health, Transplant Institute, 2799 West Grand Boulevard, Clara Ford Pavilion, Detroit, MI, 48202, USA
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Vigués F, Etcheverry B, Perez Reggeti JI, Gaya JM, Territo A, Gallioli A, Berquin C, Basile G, Suárez JF, Fiol M, Buisan O, Riera L, Prudhomme T, Doumerc N, Pecoraro A, Breda A. Orthotopic Robot-assisted Kidney Transplantation: Surgical Technique and Preliminary Results. Eur Urol 2024; 85:556-564. [PMID: 38627151 DOI: 10.1016/j.eururo.2024.03.037] [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: 01/20/2024] [Revised: 03/05/2024] [Accepted: 03/28/2024] [Indexed: 05/18/2024]
Abstract
BACKGROUND AND OBJECTIVE Orthotopic kidney transplantation (KT) has been proposed as an option for patients ineligible for heterotopic KT. In this scenario, orthotopic robot-assisted KT (oRAKT) represents a novel, minimally invasive alternative to the open approach. Here we describe the largest oRAKT series of patients, with a focus on the surgical technique, perioperative surgical outcomes, and functional results. METHODS We queried prospectively maintained databases from three referral centers to identify patients who underwent oRAKT and evaluated surgical and functional outcomes. KEY FINDINGS AND LIMITATIONS Overall, 16 oRAKT procedures were performed between January 2020 and August 2023. These involved four donors after cardiovascular death, five donors after brain death, and seven living donors. All oRAKT procedures were carried out in the left renal fossa. The indication for oRAKT was extensive calcification of the external iliac vessels (100%), frequently associated with prior KT (31%). The median operative time was 295 min (interquartile range [IQR] 268-360) and the median rewarming time 48 min (IQR 40-54). Conversion to open surgery occurred in two cases (12%), and delayed graft function was observed in two cases (12%). Postoperative complications occurred in 11 patients (69%) and three (18%) experienced Clavien-Dindo grade >II complications. At median follow-up of 9 mo (IQR 7-17), 14 patients had a functioning graft and median creatinine of 1.49 mg/dl (IQR 1.36-1.72). CONCLUSIONS AND CLINICAL IMPLICATIONS Although oRAKT is a challenging procedure, it represents a feasible option for individuals ineligible for heterotopic KT and yields favorable perioperative and mid-term functional outcomes. PATIENT SUMMARY We evaluated outcomes of orthotopic robot-assisted kidney transplantation (KT), in which the native kidney is removed and the donor kidney is transplanted into its place, in patients who are not eligible for heterotopic KT, in which the native kidney is left in place and the donor kidney is transplanted into a new location. We found that robot-assisted surgery is a safe and feasible alternative to traditional open surgery for orthotopic KT.
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Affiliation(s)
- Francesc Vigués
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Begoña Etcheverry
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - José I Perez Reggeti
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Camille Berquin
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Urology, University Hospital Ghent, Ghent, Belgium
| | - Giuseppe Basile
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; Department of Urology, Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - José F Suárez
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Maria Fiol
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Oscar Buisan
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Lluís Riera
- Department of Urology, Hospital Universitari de Bellvitge, Universitat de Barcelona, L'Hospitalet de Llobregat, Spain
| | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Alessio Pecoraro
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
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Sekito T, Yamanoi T, Sadahira T, Yoshinaga K, Maruyama Y, Tominaga Y, Katayama S, Iwata T, Nishimura S, Bekku K, Edamura K, Kobayashi T, Kobayashi Y, Araki M. Current status and future perspectives on robot-assisted kidney autotransplantation: A literature review. Int J Urol 2024; 31:599-606. [PMID: 38366752 DOI: 10.1111/iju.15426] [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: 10/04/2023] [Accepted: 02/06/2024] [Indexed: 02/18/2024]
Abstract
This review presents the latest insights on robot-assisted kidney autotransplantation (RAKAT). RAKAT is a minimally invasive surgical procedure and represents a promising alternative to conventional laparoscopic nephrectomy followed by open kidney transplantation for the treatment of various complex urological and vascular conditions. RAKAT can be performed either extracorporeally or intracorporeally. Additionally, a single-port approach can be performed through one small incision without the need to reposition the patient. Of 86 patients undergoing RAKAT, 8 (9.3%) developed postoperative > Grade 2 Clavien-Dindo (CD) complications. Although the feasibility of RAKAT was established in 2014, the long-term efficacy and safety along with outcomes of this surgical approach are still being evaluated, and additional studies are needed. With improvements in the technology of RAKAT and as surgeons gain more experience, RAKAT should become increasingly used and further refined, thereby leading to improved surgical outcomes and improved patients' quality of life.
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Affiliation(s)
- Takanori Sekito
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Tomoaki Yamanoi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Takuya Sadahira
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kasumi Yoshinaga
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yuki Maruyama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yusuke Tominaga
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Satoshi Katayama
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Takehiro Iwata
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Shingo Nishimura
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kensuke Bekku
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Kohei Edamura
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Tomoko Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Yasuyuki Kobayashi
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
| | - Motoo Araki
- Department of Urology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama, Japan
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Piana A, Pecoraro A, Dönmez Mİ, Prudhomme T, Bañuelos Marco B, López Abad A, Campi R, Boissier R, Checcucci E, Amparore D, Porpiglia F, Breda A, Territo A. New frontiers in kidney transplantation: Towards the extended reality. Actas Urol Esp 2024; 48:337-339. [PMID: 37981169 DOI: 10.1016/j.acuroe.2023.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2023] [Accepted: 10/04/2023] [Indexed: 11/21/2023]
Affiliation(s)
- Alberto Piana
- Departmento de Urología, Universidad de Turín, Turín, Italy; Servicio de Urología, Hospital Romolo, Rocca di Neto, Italy.
| | - Alessio Pecoraro
- Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy
| | - Muhammet İrfan Dönmez
- Departmento de Urología, Facultad de Medicina de la Universidad de Estambul, Estambul, Turkey
| | - Thomas Prudhomme
- Servicio de Urología, Trasplante Renal y Andrología, Hospital Universitario de Rangueil, Toulouse, France
| | - Beatriz Bañuelos Marco
- Sección de Trasplante Renal y Urología Reconstructiva, Hospital Universitario Clínico San Carlos, Madrid, Spain
| | - Alicia López Abad
- Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy; Servicio de Urología, Hospital Clínico Universitario Virgen de la Arrixaca, Murcia, Spain
| | - Riccardo Campi
- Departmento de Medicina Experimental y Clínica, Universidad de Florencia, Florencia, Italy
| | - Romain Boissier
- Servicio de Urología y Trasplante Renal, Hospital Universitario La Conception, Marsella, France
| | - Enrico Checcucci
- Servicio de Cirugía, Instituto de Candiolo FPO-IRCCS, Candiolo, Turín, Italy
| | | | | | - Alberto Breda
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
| | - Angelo Territo
- Unidad de Uro-oncología y Trasplante Renal, Servicio de Urología, Fundación Puigvert, Universidad Autónoma de Barcelona (UAB), Barcelona, Spain
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Kim HJ, Jeong W, Lee J, Yang SJ, Lee JS, Na JC, Han WK, Huh KH. Successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience. Int J Surg 2024; 110:1586-1594. [PMID: 38052024 PMCID: PMC10942182 DOI: 10.1097/js9.0000000000000977] [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: 08/21/2023] [Accepted: 11/21/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. However, data on the feasibility and safety of performing RKT by surgeons with a lack of prior minimally invasive surgery (MIS) experience are limited. The authors aimed to evaluate the surgical and functional results of RKT and present the learning curves (LC) of RKT by a single surgeon with no prior experience in MIS. MATERIALS AND METHODS This was a retrospective study of all RKT performed between November 2019 and April 2023 at Severance Hospital in Seoul, South Korea. The authors analyzed surgical and functional outcomes, as well as complication rates of RKT in comparison to open kidney transplantation (OKT). The authors evaluated LCs using the cumulative summation method to describe the number of cases associated with the competency of a single surgeon. RESULTS A total of 50 patients who underwent RKT and 104 patients who underwent OKT were included in this study. In RKT group, the median surgical console time was 193 min (interquartile range, 172-222) and the median vascular anastomoses time was 38 min (35-44). Total operation time was 323 min (290-371) and rewarming time was 62.5 min (56.0-70.0) in RKT group compared to 210 min (190-239) and 25 min (21-30), respectively, in OKT group. Despite extended surgical durations with a robotic technique, both groups had comparable intraoperative and postoperative outcomes, as well as renal function. Estimated blood loss and post-transplant hospital stays were significantly lower in RKT group than in OKT group. LC analysis of RKT by the single surgeon revealed that surgical competence was achieved after 15 cases. CONCLUSION Even if surgeons do not have prior experience with MIS, they can rapidly overcome the LC and safely perform RKT with adequate preparation and acquisition of basic robotic surgical techniques.
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Affiliation(s)
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, Michigan, USA
| | - Juhan Lee
- Department of Surgery
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul
| | - Seok Jeong Yang
- Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, South Korea
| | | | | | | | - Kyu Ha Huh
- Department of Surgery
- The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul
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9
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Zhang R, Shen P, Xiong Y, Wu T, Wang G, Wang Y, Zhang L, Yang H, He W, Du J, Wei X, Zhang S, Qiu Z, Zhang W, Zhao Z, Tang BZ. Bright, photostable and long-circulating NIR-II nanoparticles for whole-process monitoring and evaluation of renal transplantation. Natl Sci Rev 2024; 11:nwad286. [PMID: 38213521 PMCID: PMC10776353 DOI: 10.1093/nsr/nwad286] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2023] [Revised: 10/09/2023] [Accepted: 10/31/2023] [Indexed: 01/13/2024] Open
Abstract
Kidney transplantation is the gold standard for the treatment of end-stage renal diseases (ESRDs). However, the scarcity of donor kidneys has caused more and more ESRD patients to be stuck on the waiting list for transplant surgery. Improving the survival rate for renal grafts is an alternative solution to the shortage of donor kidneys. Therefore, real-time monitoring of the surgical process is crucial to the success of kidney transplantation, but efficient methods and techniques are lacking. Herein, a fluorescence technology based on bright, photostable and long-circulating aggregation-induced emission (AIE) active NIR-II nano-contrast agent DIPT-ICF nanoparticles for the whole-process monitoring and evaluation of renal transplantation has been reported. In the aggregated state, DIPT-ICF exhibits superior photophysical properties compared with the commercial dyes IR-26 and IR-1061. Besides, the long-circulating characteristic of the AIE nano-contrast agent helps to achieve renal angiography in kidney retrieval surgery, donor kidney quality evaluation, diagnosing vascular and ureteral complications, and assessment of renal graft reperfusion beyond renovascular reconstruction, which considerably outperforms the clinically approved indocyanine green (ICG).
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Affiliation(s)
- Rongyuan Zhang
- Clinical Translational Research Center of Aggregation-Induced Emission, The Second Affiliated Hospital, School of Medicine, School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Shenzhen 518172, China
- Center for AIE Research, Shenzhen Key Laboratory of Polymer Science and Technology, Guangdong Research Center for Interfacial Engineering of Functional Materials, College of Materials Science and Engineering, Shenzhen University, Shenzhen 518061, China
| | - Ping Shen
- School of Chemistry, Xiangtan University, Xiangtan 411105, China
| | - Yu Xiong
- Center for AIE Research, Shenzhen Key Laboratory of Polymer Science and Technology, Guangdong Research Center for Interfacial Engineering of Functional Materials, College of Materials Science and Engineering, Shenzhen University, Shenzhen 518061, China
| | - Tianjing Wu
- School of Chemistry, Xiangtan University, Xiangtan 411105, China
| | - Gang Wang
- School of Chemistry, Xiangtan University, Xiangtan 411105, China
| | - Yucheng Wang
- Clinical Translational Research Center of Aggregation-Induced Emission, The Second Affiliated Hospital, School of Medicine, School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Shenzhen 518172, China
| | - Liping Zhang
- Clinical Translational Research Center of Aggregation-Induced Emission, The Second Affiliated Hospital, School of Medicine, School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Shenzhen 518172, China
- Center for AIE Research, Shenzhen Key Laboratory of Polymer Science and Technology, Guangdong Research Center for Interfacial Engineering of Functional Materials, College of Materials Science and Engineering, Shenzhen University, Shenzhen 518061, China
| | - Han Yang
- Clinical Translational Research Center of Aggregation-Induced Emission, The Second Affiliated Hospital, School of Medicine, School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Shenzhen 518172, China
| | - Wei He
- HKUST-Shenzhen Research Institute, Shenzhen 518057, China
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Jian Du
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Xuedong Wei
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Siwei Zhang
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Hong Kong, China
| | - Zijie Qiu
- Clinical Translational Research Center of Aggregation-Induced Emission, The Second Affiliated Hospital, School of Medicine, School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Shenzhen 518172, China
| | - Weijie Zhang
- Department of Urology, The First Affiliated Hospital of Soochow University, Suzhou 215006, China
| | - Zheng Zhao
- Clinical Translational Research Center of Aggregation-Induced Emission, The Second Affiliated Hospital, School of Medicine, School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Shenzhen 518172, China
- HKUST-Shenzhen Research Institute, Shenzhen 518057, China
| | - Ben Zhong Tang
- Clinical Translational Research Center of Aggregation-Induced Emission, The Second Affiliated Hospital, School of Medicine, School of Science and Engineering, Shenzhen Institute of Aggregate Science and Technology, The Chinese University of Hong Kong, Shenzhen (CUHK-Shenzhen), Shenzhen 518172, China
- Department of Chemistry, Hong Kong Branch of Chinese National Engineering Research Center for Tissue Restoration and Reconstruction, The Hong Kong University of Science and Technology, Hong Kong, China
- AIE Institute, Guangzhou 510530, China
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10
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O'Connor-Cordova MA, Ortega-Macias AG, Sancen-Herrera JP, Altamirano-Lamarque F, Del Toro AV, Del Campo AIM, Canal-Zarate P, Peddinani BK, Gonzalez-Zorrilla F, O'Connor Juarez M. Living donor robotic-assisted kidney transplant compared to traditional living donor open kidney transplant. Where do we stand now? A systematic review and meta-analysis. Transplant Rev (Orlando) 2023; 37:100789. [PMID: 37604048 DOI: 10.1016/j.trre.2023.100789] [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: 04/17/2023] [Revised: 08/02/2023] [Accepted: 08/06/2023] [Indexed: 08/23/2023]
Abstract
BACKGROUND Renal transplant is the standard of care for patients with end-stage renal disease (ESRD). Robotic-assisted kidney transplant (RAKT) has emerged as a safe minimally invasive approach with a lower complication rate than open kidney transplant (OKT). Concerns regarding ischemia times and graft function are still a matter of debate. METHODS Following PRISMA guidelines and PROSPERO registration CRD42023413774, a systematic review was performed in March 2023 on RAKT compared to OKT. Primary outcomes of interest were surgical times, ischemia times, blood loss, complication rates, and graft function. Data were analyzed using R version 4.2.2. RESULTS A total of nine studies comparing living donor RAKT to living donor OKT were included, totaling 1477 patients, out of which 508 underwent RAKT and 969 OKT. RAKT cases were highly selected as depicted in the manuscript. Cumulative analysis showed significantly longer total ischemic time (MD = 16.51; 95% CI = [9.86-23.16]) and rewarming ischemia time (MD = 11.24; 95% CI = [-0.46-22.01]) in RAKT group. No differences were found in total procedure time and time to complete anastomoses. Blood loss and transfusion rate were lower in RAKT group (MD = -53.68; 95% CI = [-89.78; -17.58]) and (RR = 0.29; 95% CI = [0.14; 0.57]), respectively. The meta-analysis revealed a lower rate of surgical site infection (SSI) (RR = 0.31; 95% CI = [0.19-0.52]) and symptomatic lymphocele (RR = 0.16; 95% CI = [0.06-0.43]) in RAKT. No difference in ileus rate was found. Pain scores were significantly lower in the RAKT group (MD = -1.14; 95% CI = [-1.59 - -0.69]; p ≤0.01). No difference in length of stay and hospital readmission were evidenced. Delayed graft function (DGF) and acute rejection rates were not different between interventions groups (RR =1.23; 95% CI = [0.40-3.74]) and (RR =0.96; 95% CI = [0.55-1.70]), respectively. No difference between groups in early graft outcomes are evident. CONCLUSIONS Our analysis suggests that RAKT is a minimally invasive, safe, and feasible procedure. It is associated with a lower complication rate and similar intraoperative, perioperative, and postoperative outcomes. Further quality studies are needed to confirm these findings.
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Affiliation(s)
- Mario A O'Connor-Cordova
- Escuela de Medicina del Tecnológico de Monterrey, Av. Morones Prieto 3000, Monterrey, Nuevo León, Mexico.
| | - Alan G Ortega-Macias
- Escuela de Medicina del Tecnológico de Monterrey, Av. Morones Prieto 3000, Monterrey, Nuevo León, Mexico
| | - Juan P Sancen-Herrera
- Escuela de Medicina del Tecnológico de Monterrey, Av. Morones Prieto 3000, Monterrey, Nuevo León, Mexico
| | | | - Alexis Vargas Del Toro
- Escuela de Medicina del Tecnológico de Monterrey, Av. Morones Prieto 3000, Monterrey, Nuevo León, Mexico
| | | | - Pia Canal-Zarate
- Facultad de Medicina Universidad Anahuac, Av. Universidad Anahuac 46, Ciudad de México, Mexico
| | - Bharat Kumar Peddinani
- Escuela de Medicina del Tecnológico de Monterrey, Av. Morones Prieto 3000, Monterrey, Nuevo León, Mexico
| | | | - Mario O'Connor Juarez
- Urology Department, Hospital Ángeles del Carmen, Tarascos 3469 -401, Guadalajara, Jalisco, Mexico
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11
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Prudhomme T, Bento L, Frontczak A, Timsit MO, Boissier R. Effect of Recipient Body Mass Index on Kidney Transplantation Outcomes: A Systematic Review and Meta-analysis by the Transplant Committee from the French Association of Urology. Eur Urol Focus 2023:S2405-4569(23)00246-8. [PMID: 37993345 DOI: 10.1016/j.euf.2023.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2023] [Revised: 10/16/2023] [Accepted: 11/08/2023] [Indexed: 11/24/2023]
Abstract
CONTEXT The impact of recipient obesity on kidney transplantation (KT) outcomes remains unclear. OBJECTIVE The aim of this study was to perform a systematic review and meta-analysis to appraise all available evidence on the outcomes of KT in obese patients (body mass index [BMI] ≥30 kg/m2) versus nonobese patients (BMI <30 kg/m2). EVIDENCE ACQUISITION A systematic review and meta-analysis was performed. Search was conducted in the MEDLINE OvidSP, Web of Science, Google Scholar, Embase, and Cochrane databases to identify all studies reporting the outcomes of KT in obese versus nonobese recipients. EVIDENCE SYNTHESIS Fifty-two articles met the inclusion criteria. Delayed graft function and surgical complications were significantly higher in obese recipients (delayed graft function: relative risk [RR]: 1.44, 95% confidence interval [CI]: 1.32-1.57, p < 0.01; surgical complications: RR: 1.74, 95% CI: 1.36-2.22, p < 0.0001). Five-year patient survival (RR: 0.96, 95% CI: 0.92-1.00, p = 0.01), 10-yr patient survival (RR: 0.90, 95% CI: 0.84-0.97, p = 0.006), and 10-yr graft survival (RR: 0.87, 95% CI: 0.79-0.96, p = 0.01) were significantly inferior in the obese group. CONCLUSIONS KT in obese recipients was associated with lower patient and graft survival, and higher delayed graft function, acute rejection, and medical and surgical complications than nonobese recipients. In the current situation of organ shortage and increasing prevalence of obesity, ways to optimize KT in this setting should be investigated. PATIENT SUMMARY Compared with nonobese population, kidney transplantation in obese recipients has inferior patient and graft survival, and higher medical and surgical complications.
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Affiliation(s)
- Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France.
| | - Lucas Bento
- Department of Urology, Kidney Transplantation and Andrology, Toulouse University Hospital, Toulouse, France
| | - Alexandre Frontczak
- Department of Urology and Kidney Transplantation, Besançon University Hospital, Besançon, France
| | - Marc-Olivier Timsit
- Department of Urology, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Romain Boissier
- Department of Urology and Kidney Transplantation, Conception University Hospital, Aix-Marseille University, Marseille, France
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12
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Hill AL, Scherer MD, Kiani A, Vachharajani N, Matson S, Cullinan DR, Martens GR, Yu J, Davidson JT, Wellen JR, Chapman WC, Doyle MB, Khan AS. The impact of a dedicated operating room team on robotic transplant program growth and fellowship training. Clin Transplant 2023; 37:e15103. [PMID: 37605386 DOI: 10.1111/ctr.15103] [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] [Received: 06/09/2023] [Revised: 08/02/2023] [Accepted: 08/07/2023] [Indexed: 08/23/2023]
Abstract
INTRODUCTION Despite considerable interest in robotic surgery, successful incorporation of robotics into transplant programs has been challenging. Lack of a dedicated OR team with expertise in both robotics and transplant is felt to be a major barrier. This paper assesses the impact of a dedicated robotic transplant team (DART) on program growth and fellowship training at one of the largest robotic transplant programs in North America. METHODS This is a single center, retrospective review of all robotic operations performed on the transplant surgery service from October 2017 to October 2022. DART was incorporated in February 2020 and included transplant first assists (RFAs), scrub technologists and circulating nurses who received robotic training. Robotic experience before and after DART was compared to assess its impact on program growth and training. RESULTS Four hundred and two robotic cases were performed by five transplant surgeons: 63 pre-DART and 339 post-DART. 40% of cases were transplant-related and 59.5%, HPB. There was a significant increase in case volume (2.5-10.6 cases/month, p < .0001) and complexity (36.5% vs. 70.3% high complexity cases, p < .0001) post-DART. RFA case coverage increased from 17% to 95%, and participation of transplant fellows as primary surgeons increased from 17% to 95% post-DART period (both p < .05). Conversion rates (9.5% vs. 4.1%) and room turn-around-times (TAT) (58.4 vs. 40.3 min) were lower post-DART (p < .05). There were no emergent conversions, conversions in transplant patients, or robot-related complications in either group. CONCLUSION OR teams with expertise in robotics and transplant surgery can accelerate growth of robotic transplant programs while maintaining patient safety.
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Affiliation(s)
- Angela L Hill
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Meranda D Scherer
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Amen Kiani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Neeta Vachharajani
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Sarah Matson
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Darren R Cullinan
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Greg R Martens
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jennifer Yu
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jesse T Davidson
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Jason R Wellen
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - William C Chapman
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Majella B Doyle
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Adeel S Khan
- Section of Abdominal Transplant, Department of General Surgery, Washington University in St. Louis, St. Louis, Missouri, USA
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Territo A, Bajeot AS, Mesnard B, Campi R, Pecoraro A, Hevia V, Piana A, Doumerc N, Breda A, Boissier R, Prudhomme T. Open versus robotic-assisted kidney transplantation: A systematic review by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Kidney Transplant Working Group. Actas Urol Esp 2023; 47:474-487. [PMID: 36965855 DOI: 10.1016/j.acuroe.2023.03.003] [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: 01/14/2023] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION In the last 20 years, robotic assisted procedures were evaluated in the field of kidney transplantation to provide a mini-invasive approach for this particularly fragile population. As a relatively new issue, few studies compared open kidney transplantation (OKT) and robotic-assisted kidney transplantation (RAKT), mostly in small cohorts. To improve current knowledge, we wanted here to gather comparative data of OKT vs RAKT in a systematic review. METHODS A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting post-operative outcomes of RAKT versus OKT. RESULTS A total of 2136 patients in 13 studies were included. Median recipient age was 42.6 years (OKT: 43.5 years and RAKT: 40.3 years). Median preemptive kidney transplantation rate was 27.1 % (OKT: 23.3 % and RAKT: 33.2 %). Median total operative time and rewarming were respectively: 235 and 49 min in OKT population; 250 and 60 min in RAKT population. Post-operative complications rates were: 26.2 % in OKT population and 17.8 % in RAKT population. Delayed graft function rates were: 4.9 % in OKT population and 2.3 in RAKT population. Mid-term functional outcomes, patient and graft survival were similar in OKT and RAKT population. CONCLUSION This systematic review showed that RAKT may be associated with a lower incidence of delayed graft function and post-operative surgical complications and similar mid-term functional outcomes, patient and graft survival, compared to OKT for end-stage renal disease patients.
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Affiliation(s)
- A Territo
- Uro-oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
| | - A S Bajeot
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France
| | - B Mesnard
- Department of Urology and Kidney Transplantation, Nantes University Hospital, Nantes, France
| | - R Campi
- Department of Urology, Florence University Hospital, Florence, Italy
| | - A Pecoraro
- Department of Urology, Florence University Hospital, Florence, Italy
| | - V Hevia
- Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - N Doumerc
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France
| | - A Breda
- Uro-oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
| | - R Boissier
- Department of Urology, La Conception University Hospital, Marseille, France
| | - T Prudhomme
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France.
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14
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Lu J, Zhao Y, Zhang H, Li T, Song D, Guan S, Maimaitili A, Wang Y, Feng W, Wang Y, Wan J, Mao G, Shi H, Yang X, Liu J, Zhao Y. Learning curve in pipeline embolization device: results from the pipeline embolization device in China post-market multicentre registry study. Int J Surg 2023; 109:2159-2167. [PMID: 37158157 PMCID: PMC10442076 DOI: 10.1097/js9.0000000000000467] [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: 03/06/2023] [Accepted: 05/01/2023] [Indexed: 05/10/2023]
Abstract
BACKGROUND Intracranial aneurysms pose a significant health issue, affecting 3-5% of the adult population. The pipeline embolization device (PED) has emerged as a promising treatment for these lesions. This study aimed to investigate the impact of operator experience on complication and poor outcome rates, as well as the learning curve for PED. METHODS A total of 217 patients were consecutively enroled from four eligible centres and divided into three groups based on the number of procedures performed: group 1 (first 10 procedures), group 2 (11-20 procedures), and group 3(>20 procedures). Major complications include operation-related ischaemic or haemorrhagic events and mass effect deterioration. Poor outcome was defined as a modified Rankin Scale score greater than 2 at discharge. Cumulative summation (CUSUM) analysis was generated to assess the learning curve according to major complications and poor outcome. RESULTS The study found that major complications and poor outcomes occurred in 5.1% and 2.3% of cases, respectively. The rate of major complications decreased from 10.0% in group 1 to 2.9% in group 3 ( P =0.053), while the rate of poor outcomes decreased from 7.5% in group 1 to 0.7% in group 3 ( P =0.015). Multivariable regression analysis adjusted for covariates showed that operator experience was associated with a lower rate of poor outcomes ( P =0.034). CUSUM analysis demonstrated that the learning curve for avoiding major complications and poor outcomes required 27 (mean=13) and 40 (mean=20) cases, respectively. CONCLUSIONS These findings suggest that PED treatment requires a learning curve of 40 cases to achieve reproducibility regarding complications and functional results. Additionally, major complications and poor outcomes significantly decreases after the first 20 procedures. CUSUM analysis can serve as a useful tool for monitoring and assessing surgical performance.
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Affiliation(s)
- Junlin Lu
- Department of Neurosurgery, West China Hospital, Sichuan University, Sichuan
| | - Yang Zhao
- Peking University International Hospital
- Beijing Tiantan Hospital
| | - Hongqi Zhang
- Xuanwu Hospital, Capital Medical University, Beijing
| | | | | | - Sheng Guan
- First Affiliated Hospital of Zhengzhou University, Zhengzhou
| | | | | | - Wenfeng Feng
- Nanfang Hospital, Southern Medical University, Guangzhou
| | - Yang Wang
- First Affiliated Hospital of Nanchang University
| | - Jieqing Wan
- Renji Hospital, School of Medicine, Shanghai Jiao Tong University
| | - Guohua Mao
- Second Affiliated Hospital of Nanchang University, Nanchang
| | - Huaizhang Shi
- First Affiliated Hospital of Harbin Medical University, Harbin, China
| | | | - Jianmin Liu
- Changhai Hospital, Naval Medical University, Shanghai
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15
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Campi R, Pecoraro A, Vignolini G, Spatafora P, Sebastianelli A, Sessa F, Li Marzi V, Territo A, Decaestecker K, Breda A, Serni S. The First Entirely 3D-Printed Training Model for Robot-assisted Kidney Transplantation: The RAKT Box. EUR UROL SUPPL 2023; 53:98-105. [PMID: 37304228 PMCID: PMC10251129 DOI: 10.1016/j.euros.2023.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/12/2023] [Indexed: 06/13/2023] Open
Abstract
Background Robot-assisted kidney transplantation (RAKT) is increasingly performed at selected referral institutions worldwide. However, simulation and proficiency-based progression training frameworks for RAKT are still lacking, making acquisition of the RAKT-specific skill set a critical unmet need for future RAKT surgeons. Objective To develop and test the RAKT Box, the first entirely 3D-printed, perfused, hyperaccuracy simulator for vascular anastomoses during RAKT. Design setting and participants The project was developed in a stepwise fashion by a multidisciplinary team including urologists and bioengineers via an iterative process over a 3-yr period (November 2019-November 2022) using an established methodology. The essential and time-sensitive steps of RAKT were selected by a team of RAKT experts and simulated using the RAKT Box according to the principles of the Vattituki-Medanta technique. The RAKT Box was tested in the operating theatre by an expert RAKT surgeon and independently by four trainees with heterogeneous expertise in robotic surgery and kidney transplantation. Surgical procedure Simulation of RAKT. Measurements Video recordings of the trainees' performance of vascular anastomoses using the RAKT Box were evaluated blind by a senior surgeon according to the Global Evaluative Assessment of Robotic Skills (GEARS) and Assessment of Robotic Console Skills (ARCS) tools. Results and limitations All participants successfully completed the training session, confirming the technical reliability of the RAKT Box simulator. Tangible differences were observed among the trainees in both anastomosis time and performance metrics. Key limitations of the RAKT Box include lack of simulation of the ureterovesical anastomosis and the need for a robotic platform, specific training instruments, and disposable 3D-printed vessels. Conclusions The RAKT Box is a reliable educational tool to train novice surgeons in the key steps of RAKT and may represent the first step toward the definition of a structured surgical curriculum in RAKT. Patient summary We describe the first entirely 3D-printed simulator that allows surgeons to test the key steps of robot-assisted kidney transplantation (RAKT) in a training environment before performing the procedure in patients. The simulator, called the RAKT Box, has been successfully tested by an expert surgeon and four trainees. The results confirm its reliability and potential as an educational tool for training of future RAKT surgeons.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- European Association of Urology Young Academic Urologists Kidney Transplantation Working Group, Arnhem, The Netherlands
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- European Association of Urology Young Academic Urologists Kidney Transplantation Working Group, Arnhem, The Netherlands
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Angelo Territo
- European Association of Urology Young Academic Urologists Kidney Transplantation Working Group, Arnhem, The Netherlands
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Karel Decaestecker
- European Association of Urology Robotic Urology Section Robot-assisted Kidney Transplantation Working Group, Arnhem, The Netherlands
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Alberto Breda
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- European Association of Urology Robotic Urology Section Robot-assisted Kidney Transplantation Working Group, Arnhem, The Netherlands
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Tan N, Sri D, Tsang D, Nitkunan T, Anderson C, Qazi H, Issa R, Walker R, Seth J. Robotic-assisted laparoscopic colposuspension for female stress urinary incontinence: a prospective series. J Robot Surg 2023; 17:125-129. [PMID: 35384594 DOI: 10.1007/s11701-022-01409-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 03/22/2022] [Indexed: 11/30/2022]
Abstract
The suspension of use of sub-urethral mesh in the UK in 2018 has seen the resurgence of colposuspension in female SUI surgery. Open and laparoscopic colposuspension techniques are well recognised. We present data from 28 robotic-assisted laparoscopic colposuspension (RALCp) procedures, reporting on technique, safety and efficacy. Approval was obtained from the hospital New and Novel Procedures Committee. All patients had urodynamic assessment prior to surgery. Data was prospectively gathered and 24-h pad usage and Urinary Incontinence Short Form Questionnaire (ICIQ-UI-SF) scores were used to assess symptom severity and quality of life. PGII scores were used to assess patient satisfaction after the procedure. Paired T test analysis was conducted. Since May 2019, robotic colposuspension has been performed in 28 patients. The mean age and BMI were 49 and 27 (kg/m2), respectively, with a mean follow-up period of 12 months. 67.9% of patients had pure urodynamic SUI and 32.1% of patients had previous anti-SUI surgery. Average operating time was 127 min, blood loss 20 ml and length of stay 2 days. There was a significant 73% improvement in mean 24-h pad usage (p = 0.001) and an improvement in mean ICIQ-UI-SF scores from 18.1 to 9.4 (p = 0.0001). Day 1 mean pain score was 5/10. This is the largest series of its kind. Robotic colposuspension is safe and feasible with significant improvements seen in quality of life scores and number of pads used per day. It presents a minimally invasive treatment option in female SUI, however needs larger volume evaluation and longer follow-up for further evaluation.
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Affiliation(s)
- Nataniel Tan
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK.
| | - D Sri
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - D Tsang
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - T Nitkunan
- Epsom and St Helier NHS Trust, Dorking Rd, Epsom, KT18 7EG, UK
| | - C Anderson
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - H Qazi
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - R Issa
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
| | - R Walker
- Epsom and St Helier NHS Trust, Dorking Rd, Epsom, KT18 7EG, UK
| | - J Seth
- St George's Hospital, Blackshaw Road, Tooting, London, SW17 0QT, UK
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Piana A, Breda A, Pecoraro A, Prudhomme T, Territo A. Comment on: "Surgeon preimplantation macroscopic graft appraisal improves risk stratification of deceased kidney donors: a prospective study". Minerva Urol Nephrol 2022; 74:805-806. [PMID: 36629811 DOI: 10.23736/s2724-6051.22.05178-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Affiliation(s)
- Alberto Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy - .,Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain -
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Thomas Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Universitat Autònoma de Barcelona - UAB, Barcelona, Spain
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Pecoraro A, Andras I, Boissier R, Hevia V, Prudhomme T, Serni S, Breda A, Campi R, Territo A. The learning curve for open and minimally-invasive kidney transplantation: a systematic review. Minerva Urol Nephrol 2022; 74:669-679. [PMID: 35622352 DOI: 10.23736/s2724-6051.22.04909-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
INTRODUCTION There is lack of evidence on the impact of surgeons' learning curve on postoperative outcomes after open (OKT) or minimally-invasive (robot-assisted) kidney transplantation (RAKT). The aim of the review was to assess the learning curve (LC) for OKT and RAKT, focusing on intra-, perioperative and functional outcomes. EVIDENCE ACQUISITION A systematic review of the English-language literature published between 01/01/2000 - 10/12/2021 was conducted using the MEDLINE (Via PubMed), Web of Science and the Cochrane Library databases according to the principles highlighted by the EAU Guidelines Office and the PRISMA statement recommendations. The review protocol was registered on PROSPERO (CRD42022301132). The overall quality of evidence was assessed according to GRADE recommendations. EVIDENCE SYNTHESIS Twelve studies were included in the qualitative analysis. Surgical competence in terms of operative and re-warming times was defined after 30 cases in OKT and after 11-35 cases in RAKT. Decreased complications rates were observed after 20-33 cases in OKT and 10-30 cases in RAKT. Optimal functional outcomes were achieved after 33 cases in OKT and 15-25 cases in RAKT. However, while a poor OKT experience did not influence the LC for RAKT, lack of robotic surgery exposure could lead to a longer LC for the robotic approach. CONCLUSIONS OKT and RAKT appear to have similar LCs and might require about 30 cases to achieve optimal surgical and functional outcomes. Previous expertise in OKT is warranted to shorten the LC for RAKT. Further research is needed to validate these thresholds using standardized reporting metrics.
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Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, Hospital Ramón y Cajal, IRYCIS, Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alberto Breda
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Puigvert Foundation, Autonomous University of Barcelona, Barcelona, Spain -
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Utilizing 3D Printing and Hydrogel casting for development of a High-Fidelity Robotic Assisted Kidney Transplant (RAKT) Surgical Training Platform. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100191] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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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: 1] [Impact Index Per Article: 0.5] [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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Britton CR, Francis I, Tay LJ, Krishnamoothy B. The role of the bedside assistant in robot-assisted surgery: A critical synthesis. J Perioper Pract 2022; 32:208-225. [PMID: 35592944 DOI: 10.1177/17504589221094136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Robot-assisted surgery has grown exponentially since its inception and first approval in the United States in the year 2000. The surgeon operating with the assistance of the robot sits remotely to the patient and another practitioner assists at the bedside. The role of the bedside assistant and the training that is required to undertake this role are understudied topics. AIM To explore the functions, training and professional development of the bedside assistant in robot-assisted surgery and propose the necessary foundations for the safe enactment of the role in the United Kingdom. METHODS Through critical interpretative synthesis, relevant literature was systematically searched and analysed to inform integration of evidence. RESULTS Seventy-three studies were retrieved from the literature, across several health care disciplines and surgical specialities. These were critically analysed to inform a theoretically sound account grounded on evidence. CONCLUSION The role, functions and skills of the bedside assistant in robot-assisted surgery vary across contexts. These were analysed and critically synthetised to produce several keys to the success of bedside assistants in robot-assisted surgery in the context of the United Kingdom and of its national regulations.
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Affiliation(s)
| | - Indu Francis
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
| | - Li June Tay
- Cambridge University Hospitals NHS Foundation Trust, Cambridge, UK
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22
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Wang W, Zhuang M, Li S, Shen Y, Lan R, Wu Y, Wang F. Exploring training dental implant placement using static or dynamic devices among dental students. EUROPEAN JOURNAL OF DENTAL EDUCATION : OFFICIAL JOURNAL OF THE ASSOCIATION FOR DENTAL EDUCATION IN EUROPE 2022. [PMID: 35579548 DOI: 10.1111/eje.12825] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/09/2021] [Revised: 04/11/2022] [Accepted: 05/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND Static computer-assisted surgery (s-CAIS) and dynamic computer-assisted implant surgery (d-CAIS) are the main digital approaches in guiding dental implant placement. PURPOSE The aim of this study was to explore and compare the learning curves for s-CAIS and d-CAIS by beginners. MATERIALS AND METHODS Three dental students used each dental model for drilling five positions with missing teeth. Operators performed the drilling test for five sets of dental models with an interval of 7 ± 1 days assisted by the d-CAIS system. After a six-month break, the same students performed the drilling test again in the same way but with the s-CAIS system. A total of thirty models were used, and 150 implants were inserted. The operation time and relative deviations were recorded and calculated. Correlations between various deviation parameters and attempts were tested with independent-samples Kruskal-Wallis tests. RESULTS A significant difference between the two groups was found in the operation time (p < .001). For accuracy, the difference was found in the first attempt of coronal and apical deviations but disappeared as the training went on. As the practice progressed, improvement was evident in the d-CAIS group but not in the s-CAIS group. When reaching the plateau stage of the learning curve of the d-CAIS group (after five attempts), the influence of different methods of guidance was limited between the two groups. CONCLUSIONS A learning curve effect was found in d-CAIS but not in s-CAIS in vitro tests by beginners. The operating procedure of dynamic navigated and static template-guided implant placement was easy to master.
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Affiliation(s)
- Wenying Wang
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Minjie Zhuang
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Shunshun Li
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Yue Shen
- College of Stomatology, Shanghai Jiao Tong University, Shanghai, China
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
| | - Rong Lan
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiqun Wu
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Department of Second Dental Center, Shanghai Ninth People's Hospital, College of Stomatology, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
| | - Feng Wang
- National Center for Stomatology, Shanghai, China
- National Clinical Research Center for Oral Diseases, Shanghai, China
- Shanghai Key Laboratory of Stomatology, Shanghai, China
- Research Unit of Oral and Maxillofacial Regenerative Medicine, Chinese Academy of Medical Sciences, Shanghai, China
- Department of Oral Implantology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Campi R, Pecoraro A, Li Marzi V, Tuccio A, Giancane S, Peris A, Cirami CL, Breda A, Vignolini G, Serni S. Robotic Versus Open Kidney Transplantation from Deceased Donors: A Prospective Observational Study. EUR UROL SUPPL 2022; 39:36-46. [PMID: 35528789 PMCID: PMC9068739 DOI: 10.1016/j.euros.2022.03.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/05/2022] [Indexed: 11/28/2022] Open
Abstract
Background While robot-assisted kidney transplantation (RAKT) from living donors has been shown to achieve favourable outcomes, there is a lack of evidence on the safety and efficacy of RAKT as compared with the gold standard open kidney transplantation (OKT) in the setting of deceased donors, who represent the source of most grafts worldwide. Objective To compare the intraoperative, perioperative, and midterm outcomes of RAKT versus OKT from donors after brain death (DBDs). Design, setting, and participants Data from consecutive patients undergoing RAKT or OKT from DBDs at a single academic centre between October 2017 and December 2020 were prospectively collected. Intervention RAKT or OKT. Outcome measurements and statistical analysis The primary outcomes were intraoperative adverse events, postoperative surgical complications, delayed graft function (DGF), and midterm functional outcomes. A multivariable logistic regression analysis assessed the independent predictors of DGF, trifecta, and suboptimal graft function (estimated glomerular filtration rate [eGFR] <45 ml/min/1.73 m2) at the last follow-up. Results and limitations Overall, 138 patients were included (117 [84.7%] OKTs and 21 [15.3%] RAKTs). The yearly proportion of RAKT ranged between 10% and 18% during the study period. The OKT and RAKT cohorts were comparable regarding all graft-related characteristics, while they differed regarding a few donor- and recipient-related factors. The median second warm ischaemic time, ureterovesical anastomosis time, postoperative complication rate, and eGFR trajectories did not differ significantly between the groups. A higher proportion of patients undergoing OKT experienced DGF; yet, at a median follow-up of 31 mo (interquartile range 19–44), there was no difference between the groups regarding the dialysis-free and overall survival. At the multivariable analysis, donor- and/or recipient-related factors, but not the surgical approach, were independent predictors of DGF, trifecta, and suboptimal graft function at the last follow-up. The study is limited by its nonrandomised nature and the small sample size. Conclusions Our study provides preliminary evidence supporting the noninferiority of RAKT from DBDs as compared with the gold standard OKT in carefully selected recipients. Patient summary Kidney transplantation using kidneys from deceased donors is still being performed with an open surgical approach in most transplant centres worldwide. In fact, no study has compared the outcomes of open and minimally invasive (robotic) kidney transplantation from deceased donors. In this study, we evaluated whether robotic kidney transplantation using grafts from deceased donors was not inferior to open kidney transplantation regarding the intraoperative, postoperative, and midterm functional outcomes. We found that, in experienced hands and provided that there was a time-efficient organisation of the transplantation pathway, robotic kidney transplantation from deceased donors was feasible and achieved noninferior outcomes as compared with open kidney transplantation.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- Corresponding author. Chirurgia Urologica Robotica Mini-Invasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Viale San Luca, 50134 Firenze, Italy. Dipartimento di Medicina Sperimentale e Clinica, Università degli Studi di Firenze, Largo Brambilla, 3, 50134 Firenze, Italy. Tel. +39 055 2758020; Fax: +39 0552758014.
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Agostino Tuccio
- Unit of Urological Oncologic Minimally-Invasive Robotic Surgery and Andrology, University of Florence, Careggi Hospital, Florence, Italy
| | - Saverio Giancane
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Adriano Peris
- Intensive Care Unit and Regional ECMO Referral Centre, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy
| | - Calogero Lino Cirami
- Nephrology, Dialysis and Transplantation Unit, Careggi University Hospital, Florence, Italy
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- European Association of Urology (EAU) Robotic Urology Section (ERUS)—Robot-assisted Kidney Transplantation (RAKT) Working Group, the Netherlands
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
- European Association of Urology (EAU) Robotic Urology Section (ERUS)—Robot-assisted Kidney Transplantation (RAKT) Working Group, the Netherlands
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Slagter JS, Outmani L, Tran KTCK, Ijzermans JNM, Minnee RC. Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: A systematic review and meta-analyses. Int J Surg 2022; 99:106264. [PMID: 35183735 DOI: 10.1016/j.ijsu.2022.106264] [Citation(s) in RCA: 21] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Revised: 11/23/2021] [Accepted: 02/09/2022] [Indexed: 12/21/2022]
Abstract
BACKGROUND Robot-assisted kidney transplantation (RAKT) has emerged as an alternative for kidney transplant recipients with the potential benefits of minimally invasive surgery. The aim of this systematic review and meta-analysis is to compare the clinical outcomes of RAKT with open kidney transplantation (OKT). METHODS MEDLINE, Embase, Web of Science and Cochrane databases were systematically searched. Baseline characteristics, intraoperative and postoperative outcomes were collected, as well as long-term renal function and data on graft and patient survival. RESULTS Eleven studies were included, which compared 482 RAKT procedures with 1316 OKT procedures. RAKT was associated with lower a risk of surgical site infection (Risk ratio (RR) = 0.15, p < 0.001), symptomatic lymphocele (RR = 0.20, p = 0.03), less postoperative pain (Mean difference (MD) = -1.38 points, p < 0.001), smaller incision length (MD = -8.51 cm, p < 0.001), and shorter length of hospital stay (MD = -1.69 days, p = 0.03) compared with OKT. No difference was found in renal function, graft, and patient survival. CONCLUSIONS RAKT is a safe and feasible alternative to OKT with less surgical complications without compromising renal function, graft and patient survival.
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Affiliation(s)
- Julia S Slagter
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC Transplant Institute, Rotterdam, the Netherlands
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Breda A, Territo A, Gallioli A. Re: Robotic Kidney Transplantation with Regional Hypothermia Versus Open Kidney Transplantation for Patients with End Stage Renal Disease: An Ideal Stage 2B Study. Eur Urol 2022; 81:618-619. [DOI: 10.1016/j.eururo.2022.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2022] [Accepted: 02/08/2022] [Indexed: 11/26/2022]
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Application of Rigid Bronchoscopy for Emergent Removal of Tracheobronchial Foreign Body in Paediatric Cases: A Learning Curve Study. The Journal of Laryngology & Otology 2021; 136:1130-1134. [PMID: 34911589 DOI: 10.1017/s0022215121003911] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Abstract
PURPOSE OF REVIEW Donor hysterectomy for live donor uterus transplantation was from the start performed by laparotomy, but minimal invasive surgery has entered the scene. In particular robotic-assisted laparoscopy is used since robotics is advantageous in the complex donor hysterectomy surgery in narrow space. This review covers the development and benefits of robotics and the published robotic donor hysterectomy experiences. RECENT FINDINGS Robotic donor hysterectomy publications are scarce with eight cases in Sweden, five in USA, and one each in China and Spain. Robotics have been performed for either the entire donor hysterectomy or with conversion to laparotomy for the last steps of the surgical procedure. The total operative times are in line with open surgery, although a decrease is expected in the future. The estimated blood loss and hospital stays are less than at open surgery. The complication panorama includes hydronephrosis, ureteric fistula and pressure alopecia. Live births with healthy babies have been reported. SUMMARY In uterus transplantation, robotic live donor hysterectomy has proven to be feasible, safe and associated with successful live births. The robotic donor hysterectomy is a low-volume procedure and an international registry to gather collective information is crucial for further evaluation and development.
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Affiliation(s)
| | - Niclas Kvarnström
- Department of Transplantation, Sahlgrenska Academy at University of Gothenburg, Gothenburg
| | - Mats Brännström
- Department of Obstetrics and Gynecology
- Stockholm IVF-EUGIN, Stockholm, Sweden
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Brännström M, Belfort MA, Ayoubi JM. Uterus transplantation worldwide: clinical activities and outcomes. Curr Opin Organ Transplant 2021; 26:616-626. [PMID: 34636769 DOI: 10.1097/mot.0000000000000936] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Women with absolute uterine factor infertility, because of uterine absence, or the presence of a nonfunctional uterus, were regarded as being untreatable until 2014 when the first birth following uterus transplantation (UTx) took place in Sweden. This proof-of-concept occurred in a woman with Mayer-Rokitansky-Küster-Hauser syndrome (MRKHs) with congenital uterine absence, who received a uterus from a 61-year-old live donor (LD). Since then, several births after UTx have occurred in Sweden and subsequently in other countries, including both LD and deceased donor (DD) transplants. A great majority of the recipients were women with MRKHs. The efficiency and safety of UTx can be determined only when a complete study cohort of transplanted women have reached the definitive endpoint of graft hysterectomy. The different outcomes of transplanted women include graft failure, as well as graft survival with failure to achieve livebirth, or livebirth(s). Published data from a completed trial are not yet available. The results that we have to rely on are reports of completed surgeries and interim outcomes that may be as early as a few months after surgery and up to several years after UTx. The purpose of this review is to give an update on all published clinical UTx data and major results, including live births up to mid 2021. RECENT FINDINGS The interim results of a number of UTx studies have been published. LD UTx procedures have been reported from four European countries (Sweden, the Czech Republic, Germany, Spain), four Asian nations (Saudi Arabia, India, China, Lebanon), as well as some from the USA. DD UTx procedures have been reported from Turkey, the Czech Republic, the USA and Brazil. To our knowledge, there also exist unpublished UTx cases from some of the countries mentioned above and from at least four other countries (Serbia, France, Mexico, Italy). We estimate that at least 80 UTx procedures have been performed, resulting in more than 40 births. The present study includes only data from published, peer-reviewed, research papers. The results of 62 UTx cases show an overall surgical success rate, as defined by a technically successful transplantation with a subsequent regular menstrual pattern, of 76%. The success rates for LD and DD UTx procedures were 78% and 64%, respectively. The rate of serious postsurgical complications requiring invasive or radiological intervention was 18% for LDs and 19% for recipients. The cumulative live birth rate in successful UTx procedures is estimated to be above 80%. Twenty-four births after UTx have been reported and the results show a high rate of preterm birth, with an associated high proportion of respiratory distress syndrome. SUMMARY UTx has proven to be a successful treatment for uterine factor infertility at several centers around the world. The modest success rate and the fairly high complication rate among LDs, indicate that further research and development under strict governance are needed before this option should be widely offered.
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Affiliation(s)
- Mats Brännström
- Department of Obstetrics and Gynecology, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Göteborg
- Stockholm IVF-EUGIN, Stockholm, Sweden
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch - Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
| | - Michael A Belfort
- Department of Obstetrics and Gynecology, Baylor College of Medicine, Houston, Texas, USA
| | - Jean Marc Ayoubi
- Department of Obstetrics, Gynecology and Reproductive Medicine, Hospital Foch - Faculté de Medicine Paris Ouest (UVSQ), Suresnes, France
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Abstract
While cadaveric dissection has stood the test of time because of its widely accepted educational value by experienced surgeons, the introduction advances in 3D printing and biomaterial technologies could potentially provide alternative tools for surgical training. This novel concept in simulation (physical reality) would encompass all the benefits of cadavers in terms of realism and clinical relevance without any of its ethical, infection, safety, and financial concerns.
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Affiliation(s)
- Ahmed Ghazi
- Urology department, University of Rochester, 158 Sawgrass Drive, Rochester, NY 14642, USA.
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30
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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: 0] [Impact Index Per Article: 0] [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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31
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Ekşi M, Şahin S, Evren İ, Arıkan Y, Akbay FG, Karadağ S, Güler AF, Çelik Z, Apaydın S, İhsan Taşçı A, Tuğcu V. Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period? Int J Clin Pract 2021; 75:e14288. [PMID: 33928721 DOI: 10.1111/ijcp.14288] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Accepted: 04/23/2021] [Indexed: 02/02/2023] Open
Abstract
PURPOSE Purpose of this study is to investigate the quality of life (QoL) in patients with end-stage renal disease who underwent open or robot-assisted kidney transplantation (OKT and RAKT). MATERIALS AND METHODS Patients who underwent OKT and RAKT at Bakirkoy Sadi Konuk Training and Research Hospital between June 2016 and December 2018 constituted the target population of this study. The patient group was divided into two groups as per the surgical technique (ie, open vs. robot-assisted). Demographic data, preoperative and postoperative data of all patients were collected prospectively. The QoL of the patients was assessed preoperatively and on the postoperative 30th day. RESULTS Sixty-seven patients who underwent OKT and 60 patients who underwent RAKT were included. The mean patient age and BMI were calculated as 40.9 ± 11.6 years and 24.4 ± 2.9 kg/m2 , respectively. Patients in the RAKT group were significantly younger than the patients in the OKT group (P = .002). There were no significant differences between the two groups in terms of gender, BMI, ASA and the ratio of premptive patients. The mean preoperative hemoglobin level was significantly higher in the OKT group than the RAKT group (P = .003). While mean total ischemia time was shorter in the "open" group, intraoperative blood loss and incision length were shorter in the RAKT group. Duration of surgical drainage and hospital stay was shorter in the "robot-assisted" group. There was no significant difference between the groups in terms of SF-36 subparameters preoperatively. The physical component scores of the QoL questionnaire revealed that postoperative impairment of quality of life in the early postoperative period was more significant in the OKT than the RAKT. CONCLUSION Patients who underwent RAKT have a higher QoL than the patients who were treated with OKT as per their self-reported QoL scores in the early postoperative period.
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Affiliation(s)
- Mithat Ekşi
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Selçuk Şahin
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - İsmail Evren
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Yusuf Arıkan
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Fatih Gökhan Akbay
- Department of Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Serdar Karadağ
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ahmet Faysal Güler
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Zülal Çelik
- Department of Psychiatry, Karaman Training and Research Hospital, Karaman, Turkey
| | - Süheyla Apaydın
- Department of Nephrology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Ali İhsan Taşçı
- Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey
| | - Volkan Tuğcu
- Deparment of Urology, Bahçelievler Memorial Hospital, Istanbul, Turkey
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32
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Sessa F, Campi R, Granieri S, Tuccio A, Polverino P, Spatafora P, Sebastianelli A, Cocci A, Rivetti A, Gacci M, Carini M, Serni S, Oriti R, Minervini A. Proctored Step by Step Training Program for GreenLight Laser Anatomic Photovaporization of the Prostate: A Single Surgeon's Experience. Front Surg 2021; 8:705105. [PMID: 34395511 PMCID: PMC8358301 DOI: 10.3389/fsurg.2021.705105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Accepted: 06/29/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: To evaluate the feasibility and safety of a proctored step-by-step training program for GreenLight laser anatomic photovaporization (aPVP) of the prostate. Methods: Data from patients undergoing aPVP between January 2019 and December 2020 operated by a single surgeon following a dedicated step-by-step proctored program were prospectively collected. The procedure was divided into five modular steps of increasing complexity. Preoperative patients' data as well as total operative time, energy delivered on the prostate and postoperative data, were recorded. Then, we assessed how the overall amount of energy delivered and the operative times varied during the training program. Surgical steps were analyzed by cumulative summation. Univariable and multivariable regression models were built to assess the predictors of the amount of energy delivered on the prostate. Results: Sixty consecutive patients were included in the analysis. Median prostate volume was 56.5 mL. The training program was succesfully completed with no intraoperative or meaningful post-operative complications. The energy delivered reached the plateau after the 40th case. At multivariable analysis, increasing surgeon experience was associated with lower amounts of energy delivered as well as lower operative times. Conclusions: A step-by-step aPVP training program can be safely performed by surgeons with prior endoscopic experience if mentored by a skilled proctor. Considering the energy delivered as an efficacy surrogate metrics (given its potential impact on persistent postoperative LUTS), 40 cases are needed to reach a plateau for aPVP proficiency. Further studies are needed to assess the safety of our step-by-step training modular program in other clinical contexts.
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Affiliation(s)
- Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Stefano Granieri
- Azienda Socio-Sanitaria Territoriale (ASST)-Brianza, General Surgery Unit, Vimercate, Italy
| | - Agostino Tuccio
- Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Polverino
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Cocci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Anna Rivetti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Carini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Rino Oriti
- Unit of Urology, S.Stefano Hospital, University of Florence, Prato, Italy
| | - Andrea Minervini
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.,Unit of Urological Oncologic Minimally Invasive Robotic Surgery and Andrology, Careggi Hospital, University of Florence, Florence, Italy
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33
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Garcia LE, Parra N, Gaynor JJ, Baker L, Guerra G, Ciancio G. Clinical Outcomes Following Single vs. Multiple Vessel Living-Donor Kidney Transplantation: A Retrospective Comparison of 210 Patients. Front Surg 2021; 8:693021. [PMID: 34195224 PMCID: PMC8236516 DOI: 10.3389/fsurg.2021.693021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022] Open
Abstract
Background: The use of living-donor kidney allografts with multiple vessels continues to rise in order to increase the donor pool. This requires surgeons to pursue vascular reconstructions more often, which has previously been associated with a higher risk of developing early post-transplant complications. We therefore wanted to investigate the prognostic role of using living-donor renal allografts with a single artery (SA) vs. multiple arteries (MA) at the time of transplant. Methods: We retrospectively analyzed a cohort of 210 consecutive living-donor kidney transplants performed between January, 2008 and March, 2019, and compared the incidence of developing postoperative complications and other clinical outcomes between SA vs. MA recipients. Results: No differences were observed between SA (N = 161) and MA (N = 49) kidneys in terms of the incidence of developing a postoperative (or surgical) complication, a urologic complication, hospital length of stay, delayed graft function, estimated glomerular filtration rate at 3 or 12 mo post-transplant, and graft survival. Conclusions: The use of live-kidney allografts with MA requiring vascular reconstruction shows excellent clinical outcomes and does not increase the risk of developing postoperative complications or other adverse outcomes when compared with SA renal allografts.
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Affiliation(s)
- Leonardo E Garcia
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Natalia Parra
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Jeffrey J Gaynor
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.,Departments of Surgery and Urology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Lauren Baker
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Giselle Guerra
- Division of Nephrology, Department of Medicine, Miami Transplant Institute, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Gaetano Ciancio
- Jackson Memorial Hospital, University of Miami Miller School of Medicine, Miami, FL, United States.,Departments of Surgery and Urology, University of Miami Miller School of Medicine, Miami, FL, United States
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34
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Territo A, Piana A, Fontana M, Diana P, Gallioli A, Gaya JM, Huguet J, Gavrilov P, Rodríguez-Faba Ó, Facundo C, Guirado L, Palou J, Mottrie A, Breda A. Step-by-step Development of a Cold Ischemia Device for Open and Robotic-assisted Renal Transplantation. Eur Urol 2021; 80:738-745. [PMID: 34059396 DOI: 10.1016/j.eururo.2021.05.026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/20/2021] [Indexed: 01/03/2023]
Abstract
BACKGROUND Kidney transplantation (KT) is the best renal replacement treatment. The rewarming time is associated with ischemia/reperfusion damage. In both the open (open KT [OKT]) and the robotic (robotic-assisted KT [RAKT]) approaches, ice slush is used to maintain graft temperature (T°) below 20 °C. This may result in nonhomogeneous graft T° maintenance and, particularly during RAKT where the graft is completely inside the abdominal cavity, rises concerns regarding systemic hypothermia. OBJECTIVE To design a cold ischemia device (CID) to maintain a constant and homogeneous low graft T° during surgery. DESIGN, SETTING, AND PARTICIPANTS In IDEAL phase 0, a CID was developed and tested to determine its cooling effect on the kidney inside a closed system at 37.5 °C, by comparing it with kidney alone versus a gauze-jacket filled with ice slush. The CID was evaluated in pigs undergoing OKT and RAKT, assessing feasibility and adverse reactions. In IDEAL phase 1, the CID was tested in human OKT and RAKT. SURGICAL PROCEDURE OKT and RAKT. MEASUREMENTS In all phases, T° was evaluated at scheduled time points. RESULTS AND LIMITATIONS In the preliminary tests of IDEAL phase 0, the CID was able to maintain a low graft T° and superiority to other groups (p = 0.002). In the in vivo animal model, the CID maintained a low and constant graft T° in OKT (n = 3) and RAKT (n = 3), with a mean T° at 50 min of 10.8 °C and 14.9 °C, respectively. IDEAL phase 1 demonstrated feasibility of both approaches (OKT, n = 2 and RAKT, n = 3) using the CID, and graft T° never exceeded 20 °C (mean T°: OKT 15.7 °C vs RAKT 18.3 °C). No complications were recorded. The main limitation consists in the low number of participants. CONCLUSIONS The CID assured a constant low graft T° during rewarming time, in both OKT and RAKT. PATIENT SUMMARY A cold ischemia device (CID) is the first step toward a feasible, safe, and reproducible method to maintain a low graft temperature during surgery. The employment of a CID may optimize the functional outcomes.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Alberto Piana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain.
| | - Matteo Fontana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Jordi Huguet
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Pavel Gavrilov
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Óscar Rodríguez-Faba
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Carmen Facundo
- Department of Nephrology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Lluis Guirado
- Department of Nephrology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
| | | | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Spain
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35
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Kaouk J, Eltemamy M, Aminsharifi A, Schwen Z, Wilson C, Abou Zeinab M, Garisto J, Lenfant L, Wee A. Initial Experience with Single-port Robotic-assisted Kidney Transplantation and Autotransplantation. Eur Urol 2021; 80:366-373. [PMID: 33810922 DOI: 10.1016/j.eururo.2021.03.002] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 03/05/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Compared with the standard open approach, multiport robotic-assisted kidney transplantation (RAKT) has emerged as a less morbid alternative. The use of a single-port robotic approach for kidney transplantation (KT) is presented in this study as having the potential for further reducing the morbidity of KT. OBJECTIVE To present the technique and evaluate perioperative and short-term (≤1 yr) postoperative outcomes of single-port RAKT. DESIGN, SETTING, AND PARTICIPANTS Prospective evaluation of peri- and postoperative outcomes in patients who underwent allograft KT (n = 6) or kidney autotransplantation (n = 3). The IDEAL model (www.ideal-collaboration.net/framework) for safe surgical innovation was used. SURGICAL PROCEDURE Kidney allografts from living or deceased donors were transplanted into six patients with end-stage renal disease. Single-port robotic surgery was performed through a 5-cm midline periumbilical abdominal incision with transperitoneal or extraperitoneal approaches. With similar incision and technique, the right or left kidney was removed and autotransplantation was performed in three patients. MEASUREMENTS Intra- and postoperative variables, and outcomes were assessed with a descriptive analysis. RESULTS AND LIMITATIONS Single-port RAKT procedures were completed successfully, with total operative and vascular anastomosis times ranging from 300 to 450 mins and from 52 to 92 mins, respectively. All six patients had excellent graft function with serum creatinine levels at the last follow-up (2 wk to 1 yr), ranging from 1.2 to 1.5 mg/dl. Renal autotransplantation was also completed successfully with a single-port robotic approach in three patients. The total operative and vascular anastomosis times ranged from 510 to 600 mins and from 65 to 83 mins, respectively. In all three cases, serum creatinine levels remained normal after the surgery and during follow-up, and all remained symptom-free at the time of this writing (4-8 mo after their surgeries). CONCLUSIONS In this initial experience, single-port RAKT is feasible with potential benefits such as offering true single-site minimally invasive surgery, extraperitoneal approach, less morbidity, and comparable short-term graft functional outcomes. PATIENT SUMMARY We presented the initial experience with the application of single-port robotic surgery for kidney transplantation and autotransplantation. This technique was found to be safe and effective, with promising postoperative outcomes and potentially with less morbidity.
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Affiliation(s)
- Jihad Kaouk
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA.
| | - Mohamed Eltemamy
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alireza Aminsharifi
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Zeyad Schwen
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Clark Wilson
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Mahmoud Abou Zeinab
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Juan Garisto
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Louis Lenfant
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
| | - Alvin Wee
- Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, OH, USA
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36
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Grammens J, Schechter MY, Desender L, Claeys T, Sinatti C, VandeWalle J, Vermassen F, Raes A, Vanpeteghem C, Prytula A, Silay MS, Breda A, Decaestecker K, Spinoit AF. Pediatric Challenges in Robot-Assisted Kidney Transplantation. Front Surg 2021; 8:649418. [PMID: 33842532 PMCID: PMC8030256 DOI: 10.3389/fsurg.2021.649418] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical–material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.
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Affiliation(s)
- Julien Grammens
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Michal Yaela Schechter
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Liesbeth Desender
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Tom Claeys
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Céline Sinatti
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Johan VandeWalle
- Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frank Vermassen
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Caroline Vanpeteghem
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Agnieszka Prytula
- Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Mesrur Selçuk Silay
- Division of Pediatric Urology, Department of Urology, Biruni University, Istanbul, Turkey
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Karel Decaestecker
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Anne-Françoise Spinoit
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
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Bansal D, Chaturvedi S, Maheshwari R, Bansal A, Kumar A. Establishing a Robot-Assisted Kidney Transplant Program: Independent Evaluation of the Learning Curve and Surgical Nuances. J Endourol 2021; 35:1650-1658. [PMID: 33573461 DOI: 10.1089/end.2020.0923] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Background: Robot-assisted kidney transplantation (RAKT) is a technically challenging procedure and there has been limited reporting of its learning curve (LC), mostly by a single surgical working group. The aim of the current study was to perform an independent analysis of LC and describe our modifications in the technique of RAKT. Materials and Methods: All consecutive cases performed at our center from April 2016 to March 2020 were reviewed. LC was analyzed by using the cumulative summation method for total anastomosis time (technical outcome) and serum creatinine at days 7 and 30 (functional outcome). Patient safety was assessed by using Shewhart control charts, and a comparison of safety outcomes before and after achieving LC was done by using Chi-square or Fischer exact test as appropriate. A descriptive review of technical modifications made during our experience was conducted. Results: Ninety patients underwent robot-assisted renal transplant during the study period. LC was crossed at 24 cases (total anastomosis time) and 15 to 25 cases (serum creatinine). Shewhart control charts showed that total anastomosis time remained below alert/alarm line in 94.4%/98.9% cases, with the alert line being crossed a significantly greater number of times before the LC. Serum creatinine values remained below alert/alarm line in 85.5%/90% cases at day 7 and 92.2%/96.7% cases at day 30, with no difference made due to LC. Key technical modifications included arterial and ureteric spatulation at bench, use of polypropylene 5 to 0 holding stitch in graft vessels to facilitate intraoperative handling, keeping anterior arterial wall smaller to visualize posterior arterial wall anastomosis, and leaving a small amount of fatty tissue on the supero-lateral surface of the kidney for handling after jacket removal. Conclusion: Our LC of RAKT was crossed at 24 cases (technical outcome) and 15 to 25 cases (functional outcome). We have also detailed valuable technical modifications in the procedure.
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Affiliation(s)
- Devanshu Bansal
- Department of Urology, Renal Transplantation, Robotics and Uro-oncology, Max Hospital, New Delhi, India
| | - Samit Chaturvedi
- Department of Urology, Renal Transplantation, Robotics and Uro-oncology, Max Hospital, New Delhi, India
| | - Ruchir Maheshwari
- Department of Urology, Renal Transplantation, Robotics and Uro-oncology, Max Hospital, New Delhi, India
| | - Amit Bansal
- Department of Urology, Renal Transplantation, Robotics and Uro-oncology, Max Hospital, New Delhi, India
| | - Anant Kumar
- Department of Urology, Renal Transplantation, Robotics and Uro-oncology, Max Hospital, New Delhi, India
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Dahm-Kähler P, Kvarnström N, Alfonzo Rodriguez E, Skogsberg Dahlgren U, Brännström M. Uterus transplantation for fertility preservation in patients with gynecologic cancer. Int J Gynecol Cancer 2021; 31:371-378. [PMID: 33649004 DOI: 10.1136/ijgc-2020-001804] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2020] [Revised: 10/02/2020] [Accepted: 10/05/2020] [Indexed: 11/04/2022] Open
Abstract
Cervical and endometrial cancer may impact women interested in future fertility in approximately 5-25% of cases. The recommended treatment for patients with early stage disease is hysterectomy and/or radiation leading to infertility. This is referred to as absolute uterine factor infertility. Such infertility was considered untreatable until 2014, when the first child was born after uterus transplantation. Thereafter, multiple births have been reported, mainly from women with Mayer-Rokitansky-Küster-Hauser syndrome, with congenital uterine absence, although also from a patient with iatrogenic uterine factor infertility caused by radical hysterectomy secondary to an early stage cervical cancer 7 years before uterus transplantation. A live birth after uterus transplantation may be considered promising for many who may not otherwise have this option.Uterus transplantation is a complex process including careful patient selection in both recipients and donors, in vitro fertilization, and complex surgery in the organ procurement procedure including harvesting the vessel pedicles with the thin-walled veins. Thereafter, the transplantation surgery with anastomosis to ensure optimal blood inflow and outflow of the transplanted organ. Knowledge regarding immunosuppression and pregnancy is essential. Lastly there is the hysterectomy component as the uterus must be removed. Multidisciplinary teams working closely are essential to achieve successful uterus transplantation and, ultimately, delivery of a healthy child. Both the living and deceased donor concept may be considered and we address both the advantages and disadvantages. This review summarizes the animal research thus far published on uterus transplantation, the suggested recipient selections including former gynecologic cancer patients, the living and deceased donor uterus transplantation concepts with reported results, and updated fertility outcomes.
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Affiliation(s)
- Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg, Sweden
| | - Niclas Kvarnström
- Department of Transplantation, Sahlgrenska Academy, Goteborg, Sweden
| | | | | | - Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, Gothenburg, Sweden
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Prudhomme T, Lesourd M, Roumiguié M, Gamé X, Soulié M, Del Bello A, Kamar N, Sallusto F, Doumerc N. [Living-donor robotic-assisted kidney transplantation: French academic center experience]. Prog Urol 2021; 31:539-554. [PMID: 33612444 DOI: 10.1016/j.purol.2020.09.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Revised: 09/03/2020] [Accepted: 09/10/2020] [Indexed: 12/01/2022]
Abstract
INTRODUCTION The main objective was to report the intra-, post-operative and functional outcomes of living-donor robotic-assisted kidney transplantation (RAKT), performed by a surgeon skilled in robotic surgery. The secondary objective was to compare the results of RAKT, based on the surgeon's experience. METHODS For this retrospective cohort study, we analyzed data from consecutive patients who underwent living-donor RAKT from July 2015 to March 2020 and compared the results of RAKT according to the surgeon's experience (group 1: 1-14th RAKT versus group 2: 15-29th RAKT). RESULTS Twenty-nine living-donor RAKT were performed. The median age and BMI of the recipients were: 57.0 (44.0-66.0) years and 32.7 (23.5-39.6)kg/m2. The median overall operative time and median console time were: 140.0 (122.5-165.0) and 120.0 (107.5-137.5) minutes. The median rewarming time, arterial, venous and urinary anastomoses durations were: 35.0 (27.5-45.0), 15.0 (11.0-20.0), 12.0 (10.0-16.0), 20.0 (16.0-23.0) minutes. Two (6.9%) minor and 5 (17.2%) major (Clavien-Dindo≥III) postoperative complications occurred. At 2 years of follow-up, patient and transplant survival was 100% (n=29) and 93.1% (n=27). After the 14th RAKT, the rewarming time (P=0.01) and venous anastomosis duration (P=0.004) were statistically shorter. CONCLUSION Living-donor robotic-assisted kidney transplantation, performed by a surgeon skilled robotic surgery, ensures good functional results in the medium term. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- T Prudhomme
- Département d'urologie, de transplantation rénale et d'andrologie, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - M Lesourd
- Département d'urologie, de transplantation rénale et d'andrologie, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - M Roumiguié
- Département d'urologie, de transplantation rénale et d'andrologie, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - X Gamé
- Département d'urologie, de transplantation rénale et d'andrologie, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - M Soulié
- Département d'urologie, de transplantation rénale et d'andrologie, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - A Del Bello
- Département de néphrologie et de transplantation d'organe, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - N Kamar
- Département de néphrologie et de transplantation d'organe, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - F Sallusto
- Département d'urologie, de transplantation rénale et d'andrologie, centre hospitalier universitaire de Toulouse, Toulouse, France
| | - N Doumerc
- Département d'urologie, de transplantation rénale et d'andrologie, centre hospitalier universitaire de Toulouse, Toulouse, France.
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Serni S, Pecoraro A, Sessa F, Gemma L, Greco I, Barzaghi P, Grosso AA, Corti F, Mormile N, Spatafora P, Caroassai S, Berni A, Gacci M, Giancane S, Tuccio A, Sebastianelli A, Li Marzi V, Vignolini G, Campi R. Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique. Front Surg 2021; 7:588215. [PMID: 33521044 PMCID: PMC7844329 DOI: 10.3389/fsurg.2020.588215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes. Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes. Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6–90) ml/min/1.73 m2. In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195–258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140–255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m2. Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.
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Affiliation(s)
- Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Isabella Greco
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Barzaghi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Corti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicola Mormile
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Caroassai
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Saverio Giancane
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Agostino Tuccio
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Van Praet C, Lambert E, Desender L, Van Parys B, Vanpeteghem C, Decaestecker K. Total Intracorporeal Robot Kidney Autotransplantation: Case Report and Description of Surgical Technique. Front Surg 2020; 7:65. [PMID: 33425979 PMCID: PMC7786393 DOI: 10.3389/fsurg.2020.00065] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2020] [Accepted: 08/05/2020] [Indexed: 12/13/2022] Open
Abstract
Introduction and Objectives: Kidney autotransplantation can be performed in patients with complex renal or ureteral pathology not suitable for in situ reconstruction, such as renal vasculature anomalies, patients with proximal or long complex ureteral strictures, or complex oncological cases. Robot-assisted surgery allows for a high-quality vascular and ureteral anastomosis and faster patient recovery. Robot-assisted kidney autotransplantation (RAKAT) is performed in two phases: nephrectomy and pelvic transplantation. In-between, extraction of the kidney allows for vascular reconstruction or kidney modification on the bench and safe cold ischemia can be established. If no bench reconstruction is needed, total intracorporeal RAKAT (tiRAKAT) is feasible. One case report in Europe has been described; however, to our knowledge no surgical video is available. Methods: A 58 year-old woman suffered from right mid- and distal ureteral stenosis following pelvic radiotherapy 10 years prior for cervical cancer. A JJ stent was placed, but she suffered from recurrent urinary tract infections, and ultimately a nephrostomy was placed. Renogram demonstrated 43% relative right kidney function. As her bladder volume was low following radiotherapy, no Boari flap was possible and the patient refused life-long nephrostomy or nephrectomy. Therefore, tiRAKAT was performed using the DaVinci Xi system. Results: We describe our surgical technique including a video. Surgical time (skin-to-skin) was 5 h and 45 min. Warm ischemia time was 4 min, cold ischemia 55 min, and rewarming ischemia 15 min. The abdominal catheter and bladder catheter were removed on the first and second postoperative day, respectively. The JJ stent was removed after 4 weeks. The patient suffered from pulmonary embolism on the second postoperative day, for which therapeutic low molecular weight heparin was started. No further complications occurred during the first 90 postoperative days. After 7 months, overall kidney function remained stable, right kidney function dropped non-significantly from 27 to 25.2 mL/min (−6.7%) on renal scintigraphy. Conclusion: We demonstrated feasibility and, for the first time, a surgical video of tiRAKAT highlighting patient positioning, trocar placement, and intracorporeal cold ischemia technique.
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Affiliation(s)
| | - Edward Lambert
- Department of Urology, Ghent University Hospital, Ghent, Belgium
| | - Liesbeth Desender
- Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium
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Robot-Assisted versus Conventional Open Kidney Transplantation: A Meta-Analysis. BIOMED RESEARCH INTERNATIONAL 2020; 2020:2358028. [PMID: 33344632 PMCID: PMC7732374 DOI: 10.1155/2020/2358028] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 11/01/2020] [Accepted: 11/13/2020] [Indexed: 12/17/2022]
Abstract
Background Perioperative and follow-up outcomes for patients that received robot-assisted kidney transplant (RAKT), compared to patients that received conventional open kidney transplant (OKT), remain unknown. We performed a meta-analysis of controlled studies to compare the safety and efficacy of RAKT versus OKT. Methods Systematic searching of PubMed, Embase, and Cochrane Library databases was performed to identify relevant randomized or nonrandomized controlled studies. Perioperative, in-hospital, and follow-up outcomes were summarized. A random-effect model incorporating the potential heterogeneity was used to synthesize the results. Results Six nonrandomized controlled studies including 263 patients with RAKT and 804 patients with OKT were included. Pooled results showed that compared to those that received OKT, patients that received RAKT had significant higher rewarming time (mean difference (MD): 20.8 min, p < 0.001) and total ischemia time (MD: 17.8 min, p = 0.008) but a lower incidence of surgical site infection (SSI, risk ratio (RR): 0.22, p = 0.03). The incidence of delayed graft function was comparable between groups (RR: 1.10, p = 0.82), and the length of hospital stay was similar (MD: -2.03 days, p = 0.21). During a follow-up of 31 months, patients that received RAKT and OKT had similar serum creatinine levels (MD: 10.12 mmol/L, p = 0.42) and similar incidences of graft rejection (RR: 1.16, p = 0.53), graft failure (RR: 0.94, p = 0.79), and all-cause mortality (RR: 1.16, p = 0.77). Conclusion Current evidence from nonrandomized studies suggests that RAKT is associated with a lower risk of SSI and similar midterm functional and clinical efficacy compared to OKT. Randomized studies are needed to validate these findings.
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Vignolini G, Greco I, Sessa F, Gemma L, Pecoraro A, Barzaghi P, Grosso A, Corti F, Mormile N, Martiriggiano M, Berni A, Firenzuoli N, Gacci M, Giancane S, Sebastianelli A, Li Marzi V, Serni S, Campi R. The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience. Front Surg 2020; 7:583798. [PMID: 33262999 PMCID: PMC7686135 DOI: 10.3389/fsurg.2020.583798] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Accepted: 10/12/2020] [Indexed: 12/15/2022] Open
Abstract
Objective: To report the University of Florence technique for robot-assisted kidney transplantation (RAKT) from living donor (LD) and deceased donor (DD), highlighting the evolution of surgical indications and technical nuances in light of a single surgeon's learning curve. Materials and Methods: A dedicated program for RAKT from LDs was developed at our Institution in 2017 and implemented later with a specific framework for DDs. All RAKTs were performed by a single highly experienced surgeon. Data from patients undergoing RAKT between January 2017 and December 2019 were prospectively collected in a dedicated web-based data platform. In this report we provide a comprehensive step-by-step overview of our technique for RAKT, focusing on the potential differences in peri-operative and mid-term functional outcomes between LDs vs. DDs. Results: Overall, 160 KTs were performed in our center during the study period. Of these, 39 (24%) were performed with a robot-assisted laparoscopic technique, both from LDs (n = 18/39 [46%]) and from DDs (n = 21/39 [54%]). Eleven (11/39 [18%]), 13(13/39 [26%]), and 15 (15/39 [30%]) RAKTs were performed in 2017, 2018, and 2019, respectively, highlighting an increasing adoption of robotics for KT over time at our Institution. Median time for arterial (19 min for LD and 18 min for DD groups), venous (21 min for LD, 20 min for DD) and uretero–vesical (18 min for LD and 15 for DD) anastomosis were comparable between the two groups (all p > 0.05), as the median rewarming time (59 min vs. 56 min, p = 0.4). The rate of postoperative surgical complications according to Clavien–Dindo classification did not differ between the two study groups, except for Clavien–Dindo grade II complications (higher among patients undergoing RAKT from DDs, 76 vs. 44%, p = 0.042). Overall, 7/39 (18%) patients (all recipients from DDs) experienced DGF; two of them were on dialysis at last FU. Conclusions: Our experience confirms the feasibility, safety, and favorable mid-term outcomes of RAKT from both LDs and DDs in appropriately selected recipients, highlighting the opportunity to tailor the technique to specific recipient- and/or graft-characteristics. Further research is needed to refine the technique for RAKT and to evaluate the benefits and harms of robotics for kidney transplantation from DDs.
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Affiliation(s)
- Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Isabella Greco
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Barzaghi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Grosso
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Corti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicola Mormile
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Marco Martiriggiano
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Niccolò Firenzuoli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Saverio Giancane
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Saba P, Belfast E, Melnyk R, Patel A, Kashyap R, Ghazi A. Development of a High-Fidelity Robot-Assisted Kidney Transplant Simulation Platform Using Three-Dimensional Printing and Hydrogel Casting Technologies. J Endourol 2020; 34:1088-1094. [DOI: 10.1089/end.2020.0441] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Affiliation(s)
- Patrick Saba
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Elizabeth Belfast
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Rachel Melnyk
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Ankit Patel
- Department of Surgery, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Randeep Kashyap
- Department of Surgery, Transplant, University of Rochester Medical Center, Rochester, New York, USA
| | - Ahmed Ghazi
- Simulation Innovation Laboratory, Department of Urology, Transplant, University of Rochester Medical Center, Rochester, New York, USA
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Musquera M, Peri L, Ajami T, Revuelta I, Izquierdo L, Mercader C, Sierra A, Diekmann F, D'Anna M, Monsalve C, Alcaraz A. Results and Lessons Learned on Robotic Assisted Kidney Transplantation. BIOMED RESEARCH INTERNATIONAL 2020; 2020:8687907. [PMID: 32934965 PMCID: PMC7484686 DOI: 10.1155/2020/8687907] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/26/2020] [Accepted: 07/28/2020] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Nowadays, minimally invasive surgery in kidney transplantation is a reality thanks to robotic assistance. In this paper, we describe our experience, how we developed the robotic assisted Kidney transplantation (RAKT) technique, and analyze our results. Material and Methods. This is a retrospective study of all RAKTs performed at our center between July 2015 and March 2020. We describe the donor selection, surgical technique, and analyze the surgical results and complications. A comparison between the first 20 cases and the following ones is performed. RESULTS During the aforementioned period, 82 living donor RAKTs were performed. The mean age was 47.4 ± 13.4 and 50 (61%) were male. Mean body mass index was 25 ± 4.7 and preemptive in 63.7% of cases. Right kidneys and multiple arteries were seen in 14.6% and 12.2%, respectively. Mean operative and rewarming time was 197 ± 42 and 47 ± 9.6 minutes, respectively. Five cases required conversion to open surgery because of abnormal kidney vascularization. Two patients required embolization for subcapsular and hypogastric artery bleeding without repercussion. Three kidneys were lost, two of them due to acute rejection and one because venous thrombosis. Late complications requiring surgery included one kidney artery stenosis, one ureteral stenosis, two lymphoceles, and three hernia repairs. We noticed a significant reduction in time between the first 20 cases and the following ones from 248.25 ± 38.1 to 189.75 ± 25.3 (p < 0.05). With a mean follow-up time of 1.8 years (SD 1.3), the mean creatinine was 1.52 (SD 0.7) and RAKT graft survival was 98%. CONCLUSIONS The robotic approach is an attractive, minimally invasive method for kidney transplantation, yielding good results. Further studies are needed to consider it a standard approach.
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Affiliation(s)
- Mireia Musquera
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Lluis Peri
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Tarek Ajami
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Ignacio Revuelta
- Department of Nephrology and Kidney Transplant, Hospital Clínic, Barcelona 08036, Spain
| | - Laura Izquierdo
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | | | - Alba Sierra
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplant, Hospital Clínic, Barcelona 08036, Spain
| | - Maurizio D'Anna
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
| | | | - Antonio Alcaraz
- Department of Urology, Hospital Clínic, Barcelona 08036, Spain
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Can the robotic approach replace open surgery in kidney transplantation? World J Urol 2020; 39:3699-3700. [DOI: 10.1007/s00345-020-03312-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 06/12/2020] [Indexed: 10/24/2022] Open
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Vigués F, Bonet X, Etcheverry B, Fiol M, Suárez-Novo JF, Breda A, Riera L. Orthotopic robot-assisted kidney transplantation: first case report. World J Urol 2020; 39:2811-2813. [PMID: 32468111 DOI: 10.1007/s00345-020-03269-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 05/17/2020] [Indexed: 12/19/2022] Open
Affiliation(s)
- Francesc Vigués
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain.
| | - X Bonet
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - B Etcheverry
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - M Fiol
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - J F Suárez-Novo
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - A Breda
- Fundació Puigvert, Barcelona, Spain
| | - L Riera
- Department of Urology, Hospital Universitari de Bellvitge, C/ Feixa Llarga, s/n, 08907, Le'Hospitalet de Llobregat, Barcelona, Spain
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Brännström M, Dahm-Kähler P, Kvarnström N, Akouri R, Rova K, Olausson M, Groth K, Ekberg J, Enskog A, Sheikhi M, Mölne J, Bokström H. Live birth after robotic-assisted live donor uterus transplantation. Acta Obstet Gynecol Scand 2020; 99:1222-1229. [PMID: 32196630 DOI: 10.1111/aogs.13853] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Revised: 03/09/2020] [Accepted: 03/18/2020] [Indexed: 01/08/2023]
Abstract
INTRODUCTION The proof-of-concept of uterus transplantation, as a treatment for absolute uterine factor infertility, came with the first live birth after uterus transplantation, which took place in Sweden in 2014. This was after a live donor procedure, with laparotomy in both donor and recipient. In our second, ongoing trial we introduced a robotic-assisted laparoscopic surgery of the donor to develop minimal invasive surgery for this procedure. Here, we report the surgery and pregnancy behind the first live birth from that trial. MATERIAL AND METHODS In the present study, within a prospective observational study, a 62-year-old mother was the uterus donor and her 33-year-old daughter with uterine absence as part of the Mayer-Rokitansky-Küster-Hauser syndrome, was the recipient. Donor surgery was mainly done by robotic-assisted laparoscopy, involving dissections of the utero-vaginal fossa, arteries and ureters. The last part of surgery was by laparotomy. Recipient laparotomy included vascular anastomoses to the external iliac vessels. Data relating to in vitro fertilization, surgery, follow up, obstetrics and postnatal growth are presented. RESULTS Three in vitro fertilization cycles prior to transplantation gave 12 cryopreserved embryos. The surgical time of the donor in the robot was 360 minutes, according to protocol. The durations for robotic surgery for dissections of the utero-vaginal fossa, arteries and ureters were 30, 160 and 84 minutes, respectively. The remainder of donor surgery was by laparotomy. Recipient surgery included preparations of the vaginal vault, three end-to-side anastomoses (one arterial, two venous) on each side to the external iliacs and fixation of the uterus. Ten months after transplantation, one blastocyst was transferred and resulted in pregnancy, which proceeded uneventfully until elective cesarean section in week 36+1 . A healthy boy (Apgar 9-10-10) was delivered. Follow up of child has been uneventful for 12 months. CONCLUSIONS This is the first report of a live birth after use of robotic-assisted laparoscopy in uterus transplantation and is thereby a proof-of-concept of use of minimal invasive surgery in this new type of transplantation.
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Affiliation(s)
- Mats Brännström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,STOCKHOLM IVF-EUGIN, Stockholm, Sweden
| | - Pernilla Dahm-Kähler
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Niclas Kvarnström
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Randa Akouri
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Michael Olausson
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Klaus Groth
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Jana Ekberg
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Anders Enskog
- Department of Anesthesiology and Intensive Care, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | | | - Johan Mölne
- Department of Clinical Pathology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Hans Bokström
- Department of Obstetrics and Gynecology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Reply to Jinna Yao, Henry C.C. Pleass, and Howard M.H. Lau's Letter to the Editor re: Andrea Gallioli, Angelo Territo, Romain Boissier, et al. Learning Curve in Robot-assisted Kidney Transplantation: Results from the European Robotic Urological Society Working Group. Eur Urol. In press. https://doi.org/ 10.1016/j.eururo.2019.12.008. Eur Urol 2020; 77:e166-e167. [PMID: 32291108 DOI: 10.1016/j.eururo.2020.03.040] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2020] [Accepted: 03/23/2020] [Indexed: 11/23/2022]
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