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Lee SD, Savsani K, Wang SZ, Bhati C, Sambommatsu Y, Imai D, Khan A, Saeed I, Sharma A, Kumaran V, Cotterell A, Levy M, Bruno DA. Robotic versus open mini-incision living donor nephrectomy: Single centre experience. Int J Med Robot 2024; 20:e2658. [PMID: 39014883 DOI: 10.1002/rcs.2658] [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: 02/13/2024] [Revised: 06/24/2024] [Accepted: 06/29/2024] [Indexed: 07/18/2024]
Abstract
BACKGROUND Robotic surgery is associated with less tissue manipulation and earlier recovery with minimal incision. The aim of this study was to compare the short-term clinical outcomes between robotic-assisted donor nephrectomy (RDN) and open mini-incision donor nephrectomy (ODN). METHODS From 2016 to 2019, 141 cases involving RDN were analysed. Patient outcomes were compared with those of 191 patients who underwent ODN from 2010 to 2015. Demographics, operation factors, perioperative outcomes, and complications were retrospectively reviewed. RESULTS The RDN group presented with less blood loss than the ODN group (p = 0.023). The length of hospital stay was significantly shorter in the RDN group than in the ODN group (p < 0.005). The overall rate of complications was low and there was no significant difference in complication rates between the groups. CONCLUSION The robotic approach has benefits over the traditional open approach, including shorter length of hospital stay and reduced intraoperative blood loss.
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Affiliation(s)
- Seung Duk Lee
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Kush Savsani
- Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Sarah Ziqi Wang
- Department of Surgery, Cleveland Clinic Foundation, Cleveland, Ohio, USA
| | - Chandra Bhati
- Division of Transplant Surgery, Department of Surgery, University of Maryland School of Medicine, Baltimore, Maryland, USA
| | - Yuzuru Sambommatsu
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Daisuke Imai
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Aamir Khan
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Irfan Saeed
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Amit Sharma
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Vinay Kumaran
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Adrian Cotterell
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Marlon Levy
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
| | - David A Bruno
- Division of Transplant Surgery, Department of Surgery, Virginia Commonwealth University, Richmond, Virginia, USA
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Huang H, Qiu Y, Liu G, Liu X, Lin X, Wu X, Xie W, Yang X, Kong W, Chen J. Robot-assisted laparoscopic retroperitoneal donor nephrectomy: a safe and efficient improvement. World J Urol 2024; 42:243. [PMID: 38639784 DOI: 10.1007/s00345-024-04939-w] [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: 12/01/2023] [Accepted: 03/20/2024] [Indexed: 04/20/2024] Open
Abstract
PURPOSE Reducing operative injuries is important in living donor nephrectomy. The robot-assisted transperitoneal approach has some advantages than traditional laparoscopic techniques. However, longer operation time and risks of abdominal complications indicate the need for improved techniques. The aim of this study is to present the robot-assisted laparoscopic retroperitoneal donor nephrectomy and evaluate its safety and feasibility. METHODS This was a retrospective study. From June 2016 to December 2020, 218 living donors underwent robot-assisted laparoscopic retroperitoneal donor nephrectomy. Perioperative data such as operation time, warm ischemia time, length of stay and complications were collected and analyzed. To evaluate the feasibility of this surgical technique, the cumulative summation method was used to construct a learning curve. RESULTS There were 60 male and 158 female donors aged 36-72 years, with an average age of 53.1 ± 6.8 years. Three patients (1.4%) were converted to open surgery. The mean operation time was 115.4 ± 41.9 min, the warm ischemia time was 206.6 ± 146.7 s, and the length of stay was 4.1 ± 1.4 days. Complications were reported in 22 patients (10.1%), three of whom (1.4%) had Clavien‒Dindo IIIa complications. No ileus occurred. No donors were readmitted. Four patients had delayed graft function. The cumulative summation curve showed that the number needed to reach proficiency was 33. The operation time and warm ischemia time after technical proficiency were 100.4 ± 21.6 min and 142.5 ± 50.7 s, respectively. CONCLUSION Robot-assisted laparoscopic retroperitoneal donor nephrectomy is a safe and efficient technique that offers advantages of shorter operation time and no abdominal organ interference.
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Affiliation(s)
- Hongfeng Huang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Yingyin Qiu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Guangjun Liu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xinyu Liu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoli Lin
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiaoying Wu
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Wenqing Xie
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Xiuyan Yang
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Weiwei Kong
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China
| | - Jianghua Chen
- Kidney Disease Center, The First Affiliated Hospital, College of Medicine, Zhejiang University, 79 Qingchun Road, Hangzhou, 310003, Zhejiang, China.
- Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou, Zhejiang, China.
- National Key Clinical Department of Kidney Diseases, Zhejiang University, Hangzhou, Zhejiang, China.
- Institute of Nephrology, Zhejiang University, Hangzhou, Zhejiang, China.
- Zhejiang Clinical Research Center of Kidney and Urinary System Disease, Zhejiang University, Hangzhou, Zhejiang, China.
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Pelegrin T, Champy CM, Gerbaud F, Miro-Padovani M, Grimbert P, Matignon MB, Durrbach A, De La Taille A, Ingels A. Robotic-assisted laparoscopy living donor nephrectomy: Technique and results of a monocentric retrospective series. Prog Urol 2022; 32:567-576. [PMID: 35623941 DOI: 10.1016/j.purol.2022.03.009] [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: 10/19/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Robot-assisted nephrectomy for living kidney donation (LKD) has been described in the literature as a safe and reproducible technique in high volume centers with extensive robotic surgery experience. Any surgical procedure in a healthy individual ought to be safe in regards to complications. The objective of this study was to evaluate the Robotic-assisted Living Donor Nephrectomy (RLDN) experience in a robotic surgery expert center. METHODS This is a retrospective study from 11/2011 and 12/2019. In total, 118 consecutive Living Donor (LD) kidney transplants were performed at our institution. All the procedures were performed by robotic-assisted laparoscopic approach. Extraction was performed by iliac (IE), vaginal (VE) or umbilical extraction (UE). The left kidney was preferred even if the vascular anatomy was not modal. RESULTS For donors: the median operative time was 120min with 50mL of blood loss. The median warm ischemia time was 4min, with a non-significant shorter duration with the UE (4min) in comparison with IE or VE (5min). Nine patients had postoperative complications including 1 grade II (blood transfusion) and 1 grade IIIb (vaginal bleeding after VE). None of our procedures were converted to open surgeries and no deaths were reported. For the recipients: 1.7% presented delayed graft function; their median GFR at 1 year was 61mL/min/1.73m2. CONCLUSION RLDN in an expert center appears to be a safe technique. The advantages of the robot device in terms of ergonomy don't hamper the surgical outcomes. Donor, recipient and graft survivals seem comparable to the reported laparoscopic outcomes in the literature. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- T Pelegrin
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France.
| | - C M Champy
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - F Gerbaud
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - M Miro-Padovani
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - P Grimbert
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - M-B Matignon
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A Durrbach
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A De La Taille
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A Ingels
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
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