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Spaggiari M, Martinino A, Bencini G, Masrur MA, Petrochenkov E, Lian A, Olazar J, Di Cocco P, Almario-Alvarez J, Benedetti E, Tzvetanov I. Timing Considerations for Sleeve Gastrectomy in Kidney Transplant Patients: A Single Center Evaluation. Transpl Int 2024; 37:12690. [PMID: 38957660 PMCID: PMC11217181 DOI: 10.3389/ti.2024.12690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2024] [Accepted: 06/07/2024] [Indexed: 07/04/2024]
Abstract
Current scientific literature is deficient in detailing the optimal timing for conducting bariatric surgery in relation to kidney transplantation. In this study, we performed a retrospective evaluation of kidney transplant recipients with BMI >35 kg/m2. It aimed to provide data on those who received both sleeve gastrectomy (SG) and kidney transplantation (KT) simultaneously, as well as on patients who underwent SG and KT at different times, either before or after. In addition, the acceptance levels of the bariatric surgery among different scenarios were assessed. Our findings demonstrated that combined KT and SG led to successful weight loss, in contrast to undergoing kidney transplant alone, while maintaining comparable rates of graft and patient survival. Weight loss was similar between recipients who had a combined operation and those who underwent SG following the transplant. Additionally, over a median time frame of 1.7 years, patients who underwent SG before KT exhibited a statistically significant reduction in BMI at the time of the transplant. Notably, our study highlights that patients offered the combined procedure were significantly more likely to undergo SG compared to those for whom SG was presented at a different operative time than the transplant.
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Affiliation(s)
- Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Alessandro Martinino
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Giulia Bencini
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Mario A. Masrur
- Division of General, Minimally Invasive and Robotic Surgery, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Egor Petrochenkov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Amy Lian
- University of Illinois at Chicago College of Medicine, Chicago, IL, United States
| | - Joanna Olazar
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Jorge Almario-Alvarez
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
| | - Ivo Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL, United States
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2
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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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Wainstein MD, Talbot BA, Lang J, Nkansah-Amankra K, Cuffy M, Ekwenna O. A Quality Analysis of Donor Nephrectomy-Related Information on YouTube; Education or Misinformation? Transplant Proc 2023; 55:2041-2045. [PMID: 37783592 DOI: 10.1016/j.transproceed.2023.07.032] [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: 06/29/2023] [Accepted: 07/21/2023] [Indexed: 10/04/2023]
Abstract
INTRODUCTION There currently remains an urgent need to increase living kidney donation to help mitigate the high demand for waitlisted kidney failure patients. Potential kidney donors can readily access social media, particularly YouTube, to gain basic knowledge about live donor nephrectomy surgical procedures. YouTube is an open-source platform where anyone can upload videos about any topic without peer review or quality control and is frequently used for disseminating health education. This study aims to assess the quality and accuracy of information regarding live donor nephrectomy on YouTube. METHODS A YouTube search was performed using the keywords "donor nephrectomy" and "kidney transplant." A total of 57 videos were assessed for eligibility criteria. Two validated tools for evaluating health information, the DISCERN and The Patient Education Materials Assessment Tool for Audiovisual Materials tools, were used to assess YouTube video information quality, understandability, and actionability. RESULTS A total of 53 of 57 screened videos were included in this study, with 4 videos being excluded for not being primarily in the English language. The mean (SD) DISCERN score was 23.3 (±8.3), and the mean (SD) The Patient Education Materials Assessment Tool for Audiovisual Materials Understandability and Actionability scores of 41.7% (±17.5) and 8.2% (±22.9%), respectively. Although videos were generally relevant in content to donor nephrectomy, videos lacked quality information and actionable items. CONCLUSIONS Information on living donor nephrectomies is prevalent on YouTube. Our assessment using quality measures of selected videos illustrates substantial misinformation on living donor nephrectomies. YouTube has the potential to be a source of reliable and accurate information on living donor nephrectomies and donations.
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Affiliation(s)
- Matthew D Wainstein
- The University of Toledo College of Medicine Letters & Science, Toledo, Ohio
| | - Benjamin A Talbot
- The University of Toledo College of Medicine Letters & Science, Toledo, Ohio
| | - Jacob Lang
- The University of Toledo College of Medicine Letters & Science, Toledo, Ohio
| | | | - Madison Cuffy
- The University of Cincinnati Department of Surgery Subdivision of Transplant Surgery, Cincinnati, Ohio
| | - Obi Ekwenna
- The University of Toledo College of Medicine Letters & Science, Toledo, Ohio; Department of Urology, The University of Toledo Health Science Campus, Toledo, Ohio.
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Dąbek B, Dybiec J, Frąk W, Fularski P, Lisińska W, Radzioch E, Młynarska E, Rysz J, Franczyk B. Novel Therapeutic Approaches in the Management of Chronic Kidney Disease. Biomedicines 2023; 11:2746. [PMID: 37893119 PMCID: PMC10604464 DOI: 10.3390/biomedicines11102746] [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: 08/31/2023] [Revised: 10/02/2023] [Accepted: 10/06/2023] [Indexed: 10/29/2023] Open
Abstract
Chronic kidney disease (CKD) is a progressive and incurable disease that impairs kidney function. Its prevalence is estimated to affect up to 800 million individuals within the general population, and patients with diabetes and hypertension are particularly at risk. This disorder disrupts the physiological mechanisms of the body, including water and electrolyte balance, blood pressure regulation, the excretion of toxins, and vitamin D metabolism. Consequently, patients are exposed to risks such as hyperkalemia, hyperphosphatemia, metabolic acidosis, and blood pressure abnormalities. These risks can be reduced by implementing appropriate diagnostic methods, followed by non-pharmacological (such as physical activity, dietary, and lifestyle adjustment) and pharmacological strategies after diagnosis. Selecting the appropriate diet and suitable pharmacological treatment is imperative in maintaining kidney function as long as possible. Drugs such as finerenone, canakinumab, and pentoxifylline hold promise for improved outcomes among CKD patients. When these interventions prove insufficient, renal replacement therapy becomes essential. This is particularly critical in preserving residual renal function while awaiting renal transplantation or for patients deemed ineligible for such a procedure. The aim of this study is to present the current state of knowledge and recent advances, providing novel insights into the treatment of chronic kidney disease.
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Affiliation(s)
- Bartłomiej Dąbek
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jill Dybiec
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Weronika Frąk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Piotr Fularski
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Wiktoria Lisińska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewa Radzioch
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Ewelina Młynarska
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Jacek Rysz
- Department of Nephrology, Hypertension and Family Medicine, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
| | - Beata Franczyk
- Department of Nephrocardiology, Medical University of Lodz, ul. Zeromskiego 113, 90-549 Lodz, Poland
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Herrera S, Carbonell I, Cofan F, Cucchiari D, Abalde I, Bernabeu E, Sempere A, Peri L, Revuelta I, Diekmann F, Alcaraz A, Musquera M, Bodro M. Impact of robotic-assisted kidney transplantation on post-transplant infections: a case-control study. World J Urol 2023; 41:2847-2853. [PMID: 37477683 DOI: 10.1007/s00345-023-04484-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 06/07/2023] [Indexed: 07/22/2023] Open
Abstract
BACKGROUND The aim of this study was to determine the differences in the incidence, epidemiology, clinical characteristics and risk factors of infections in living donor kidney transplant recipients using robotic-assisted kidney transplantation (RAKT) and open approach. METHODS We conducted a retrospective observational study from January 2016 to December 2019. For the risk factor analysis, a matched case-control study (1:1 ratio) was performed (robotic vs open). Control subjects were matched for living donor and time of transplantation. The data included de novo immunosuppressive regimen, delayed graft function, urological complications, acute allograft rejection and incidence, clinical features, microbiological findings and outcomes of infections. RESULTS Ninety-four RAKT and 84 controls were included. There were no differences between groups in terms of age, gender, BMI, median days of hospitalization, immunosuppressive regimen, need for surgical urologic procedures post-transplantation, presence of urinary leak or acute allograft rejection. Thirty-five percent of all recipients analyzed presented an infection, mostly asymptomatic bacteriuria (49%), symptomatic urinary tract infection (31%) and surgical site infection (10%). Pseudomonas aeruginosa was the most frequent isolated microorganism in 67%, followed by E. coli (20%), Enterococcus faecalis (17%) and Klebsiella pneumoniae (10%). Eight percent of the microorganisms were multidrug resistant. The open kidney transplantation group presented more infections compared to RAKT (43 vs 27%, p = 0.04). After multivariate analysis, need for surgical urologic procedure post-transplantation (OR 6.2, 95% CI 1.1-35), BMI ≥ 30 (OR 3.6, 95% CI 1.5-9) and acute allograft rejection (OR 3.2, 95% CI 1.2-8.5) were associated with infection, whereas RAKT (OR 0.5, 95% CI 0.2-0.9) and the use of JJ catheter (OR 0.36, 95% CI 0.17-0.72) were protective factors. CONCLUSIONS Infection is a frequent event in patients receiving a living donor kidney transplant. Acute allograft rejection, need for surgical urologic procedure post-transplantation and BMI were associated with infection, whereas robotic surgery was a protective factor in living donor kidney transplantation.
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Affiliation(s)
- Sabina Herrera
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Irene Carbonell
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Frederic Cofan
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - David Cucchiari
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Iolanda Abalde
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Emilia Bernabeu
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Abiu Sempere
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Lluís Peri
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Ignacio Revuelta
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Fritz Diekmann
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Antonio Alcaraz
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain
| | - Mireia Musquera
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
| | - Marta Bodro
- Hospital Clinic de Barcelona, C. de Villarroel, 170, 08036, Barcelona, Spain.
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6
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Di Cocco P, Bencini G, Spaggiari M, Petrochenkov E, Akshelyan S, Fratti A, Zhang JC, Almario Alvarez J, Tzvetanov I, Benedetti E. Obesity and Kidney Transplantation-How to Evaluate, What to Do, and Outcomes. Transplantation 2023; 107:1903-1909. [PMID: 36855222 DOI: 10.1097/tp.0000000000004564] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/02/2023]
Abstract
Obesity is a growing issue that is spreading worldwide; its prevalence is ever increasing in patients with end-stage renal disease and represents a potential barrier to transplantation. The lack of unanimous guidelines exacerbates the current disparity in treatment, which can affect outcomes, leading to a significantly longer time on the waiting list. Multidisciplinary and multimodal management (encompassing several healthcare professionals such as nephrologists, transplant physicians and surgeons, primary care providers, and nurses) is of paramount importance for the optimal management of this patient population in a continuum from waitlisting to transplantation. Development of this guideline followed a standardized protocol for evidence review. In this review, we report on our clinical experience in transplantation of obese patients; strategies to manage this condition, including bariatric surgery, suitable timing for transplantation among this patient population, and clinical experience in robotic sleeve gastrectomy; and simultaneous robotic kidney transplantation to achieve optimal outcomes.
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Affiliation(s)
- Pierpaolo Di Cocco
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Giulia Bencini
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Mario Spaggiari
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Egor Petrochenkov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Stepan Akshelyan
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Alberto Fratti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Jing Chen Zhang
- University of Illinois College of Medicine at Chicago, Chicago, IL
| | - Jorge Almario Alvarez
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Ivo Tzvetanov
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
| | - Enrico Benedetti
- Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL
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7
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Bankar GR, Keoliya A. Robot-Assisted Surgery in Gynecology. Cureus 2022; 14:e29190. [PMID: 36259016 PMCID: PMC9572807 DOI: 10.7759/cureus.29190] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Accepted: 09/15/2022] [Indexed: 11/29/2022] Open
Abstract
The advancement of robotics-based procedures in the medical industry is the subject of this review article. The purpose of the surgical robot is to increase surgical abilities and address human shortcomings. The robot's success has been predicated on its ability to accurately and consistently repeat tasks. The following are a few objectives and quantifiable benefits of robotic technology improving surgical maneuverability and physical capabilities. In 2005, the FDA granted gynecological surgery approval for the Da Vinci surgical system. It has been quickly embraced and has already taken on a significant role at many of the locations where it is offered. It consists of a cart with robotic branches next to the patient and a high-resolution three-dimensional (3D) vision system. This study covers laparoscopy via robots in benign gynecological surgeries, myomectomy surgery, hysterectomies, endometriosis, tubal anastomosis, and sacrocolpopexy. The appropriate published studies were evaluated after a PubMed search was conducted. Additionally, procedures that may be used in the future are highlighted. In benign gynecological illness, most currently available research does not show a substantial benefit over traditional laparoscopic surgery. Robotics, however, does provide help in more complicated operations. Compared to laparoscopy, robotic assistance has a lower conversion rate to open procedures. Endo wrist movement of an automated machine during myomectomy surgery can perform proper and better suturing than traditional laparoscopy. The automated program is a noticeable improvement over laparoscopic surgery and, if price issues are resolved, can gain popularity among gynecological surgeons around the globe.
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8
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Robotic Transplant Surgery: Broadening the Playing Field. Ann Surg 2022; 275:e804. [PMID: 35081562 DOI: 10.1097/sla.0000000000005402] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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9
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Kim HJ, Yang SJ, Jeong W, Lee J, Na JC, Han WK, Huh KH. The first robotic kidney transplantation in Korea: a case report. KOREAN JOURNAL OF TRANSPLANTATION 2022; 36:61-66. [PMID: 35769429 PMCID: PMC9235531 DOI: 10.4285/kjt.21.0023] [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: 09/15/2021] [Revised: 11/11/2021] [Accepted: 11/12/2021] [Indexed: 11/29/2022] Open
Abstract
Minimally invasive surgery reduces perioperative pain and morbidity, facilitating rapid recovery. However, the field of kidney transplantation has lagged in this regard, its customary open surgical techniques going nearly unchanged until recently. Robotic kidney transplantation (RKT) is a novel and welcomed innovation yielding good surgical outcomes. In Korea, the first RKT performed (November 2019) involved a 30-year-old man (body mass index, 22 kg/m2) with end-stage hypertensive nephrosclerosis. A left donor kidney from his 28-year-old sister was successfully transplanted using the daVinci Robotic Surgical System. Transperitoneal regional hypothermia (Vattikuti Urology Institute-Medanta technique) was also implemented across the main periumbilical incision (up to 6 cm). Total operative time was 260 minutes (cold ischemia, 34 minutes; rewarming, 54 minutes), with 50 mL of blood loss. There was immediate graft function, unencumbered by surgical complications (e.g., postoperative bleeding, leakage, or lymphocele). The patient was discharged on postoperative day 8, with serum creatinine at 1.27 mg/dL. RKT with regional hypothermia may be a viable, minimally invasive intervention that is safe and effective in select patients, showing good surgical results.
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Affiliation(s)
- Hyun Jeong Kim
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Seok Jeong Yang
- Department of Surgery, CHA Bundang Medical Center, CHA University School of Medicine, Seongnam, Korea
| | - Wooju Jeong
- Vattikuti Urology Institute, Henry Ford Hospital, Detroit, MI, USA
| | - Juhan Lee
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Joon Chae Na
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Woong Kyu Han
- Department of Urology, Yonsei University College of Medicine, Seoul, Korea
| | - Kyu Ha Huh
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
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10
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Lee JH, McDonald EO, Harhay MN. Obesity Management in Kidney Transplant Candidates: Current Paradigms and Gaps in Knowledge. Adv Chronic Kidney Dis 2021; 28:528-541. [PMID: 35367021 DOI: 10.1053/j.ackd.2021.09.009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2021] [Revised: 09/07/2021] [Accepted: 09/16/2021] [Indexed: 12/18/2022]
Abstract
In this review, we discuss the increasing prevalence of obesity among people with chronic and end-stage kidney disease (ESKD) and implications for kidney transplant (KT) candidate selection and management. Although people with obesity and ESKD receive survival and quality-of-life benefits from KT, most KT programs maintain strict body mass index (BMI) cutoffs to determine transplant eligibility. However, BMI does not distinguish between visceral adiposity, which confers higher cardiovascular risks and risks of perioperative and adverse posttransplant outcomes, and muscle mass, which is protective in ESKD. Furthermore, requirements for patients with obesity to lose weight before KT should be balanced with the findings of numerous studies that show weight loss is a risk factor for death among patients with ESKD, independent of starting BMI. Data suggest that KT is associated with survival benefits relative to remaining on dialysis for candidates with obesity although recipients without obesity have higher delayed graft function rates and longer transplant hospitalization durations. Research is needed to determine the optimal body composition metrics for KT candidacy assessments and risk stratification. In addition, ESKD-specific obesity management guidelines are needed that will address the neurologic, behavioral, socioeconomic, and physical underpinnings of this increasingly common disease.
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11
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Abstract
In this paper, we focus on providing a narrative review of healthcare services in which artificial intelligence (AI) based services are used as part of the operations and analyze key elements to create successful AI-based services for healthcare. The benefits of AI in healthcare are measured by how AI is improving the healthcare outcomes, help caregivers in work, and reducing healthcare costs. AI market in healthcare sector have also a high market potential with 28% global compound annual growth rate. This paper will collect outcomes from multiple perspectives of healthcare sector including financial, health improvement, and care outcome as well as provide proposals and key factors for successful implementation of AI methods in healthcare. It is shown in this paper that AI implementation in healthcare can provide cost reduction and same time provide better health outcome for all.
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12
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Martin-Moreno PL, Shin HS, Chandraker A. Obesity and Post-Transplant Diabetes Mellitus in Kidney Transplantation. J Clin Med 2021; 10:2497. [PMID: 34198724 PMCID: PMC8201168 DOI: 10.3390/jcm10112497] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/01/2021] [Indexed: 12/14/2022] Open
Abstract
Worldwide, the prevalence obesity, diabetes, and chronic kidney disease is increasing apace. The relationship between obesity and chronic kidney disease is multidimensional, especially when diabetes is also considered. The optimal treatment of patients with chronic kidney disease includes the need to consider weight loss as part of the treatment. The exact relationship between obesity and kidney function before and after transplantation is not as clear as previously imagined. Historically, patients with obesity had worse outcomes following kidney transplantation and weight loss before surgery was encouraged. However, recent studies have found less of a correlation between obesity and transplant outcomes. Transplantation itself is also a risk factor for developing diabetes, a condition known as post-transplant diabetes mellitus, and is related to the use of immunosuppressive medications and weight gain following transplantation. Newer classes of anti-diabetic medications, namely SGLT-2 inhibitors and GLP-1 agonists, are increasingly being recognized, not only for their ability to control diabetes, but also for their cardio and renoprotective effects. This article reviews the current state of knowledge on the management of obesity and post-transplant diabetes mellitus for kidney transplant patients.
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Affiliation(s)
- Paloma Leticia Martin-Moreno
- Department of Nephrology, Clinica Universidad de Navarra, Navarra Institute for Health Research (IdiSNA), 31008 Pamplona, Spain
| | - Ho-Sik Shin
- Renal Division, Department of Internal Medicine, Gospel Hospital, Kosin University, Busan 49267, Korea;
- Transplantation Research Institute, Kosin University College of Medicine, Busan 49367, Korea
| | - Anil Chandraker
- Renal Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, USA;
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13
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Outmani L, Kimenai HJAN, Roodnat JI, Leeman M, Biter UL, Klaassen RA, IJzermans JNM, Minnee RC. Clinical outcome of kidney transplantation after bariatric surgery: A single-center, retrospective cohort study. Clin Transplant 2021; 35:e14208. [PMID: 33368652 PMCID: PMC8047925 DOI: 10.1111/ctr.14208] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2020] [Revised: 12/16/2020] [Accepted: 12/17/2020] [Indexed: 01/23/2023]
Abstract
Patients with class II and III obesity and end‐stage renal disease are often ineligible for kidney transplantation (KTx) due to increased postoperative complications and technically challenging surgery. Bariatric surgery (BS) can be an effective solution for KTx candidates who are considered inoperable. The aim of this study is to evaluate outcomes of KTx after BS and to compare the outcomes to obese recipients (BMI ≥ 35 kg/m2) without BS. This retrospective, single‐center study included patients who received KTx after BS between January 1994 and December 2018. The primary outcome was postoperative complications. The secondary outcomes were graft and patient survival. In total, 156 patients were included, of whom 23 underwent BS prior to KTx. There were no significant differences in postoperative complications. After a median follow‐up of 5.1 years, death‐censored graft survival, uncensored graft survival, and patient survival were similar to controls (log rank test p = .845, .659, and .704, respectively). Dialysis pre‐transplantation (Hazard Ratio (HR) 2.55; 95%CI 1.03–6.34, p = .043) and diabetes (HR 2.41; 95%CI 1.11–5.22, p = .027) were independent risk factors for all‐cause mortality. A kidney from a deceased donor was an independent risk factor for death‐censored graft loss (HR 1.98; 95%CI 1.04–3.79, p = .038). Patients who received a KTx after BS have similar outcomes as obese transplant recipients.
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Affiliation(s)
- Loubna Outmani
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Hendrikus J A N Kimenai
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Joke I Roodnat
- Division of Nephrology, Department of Internal Medicine, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Marjolijn Leeman
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - Ulas L Biter
- Department of Surgery, Franciscus Gasthuis & Vlietland, Rotterdam, the Netherlands
| | - René A Klaassen
- Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Robert C Minnee
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands
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14
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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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15
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IMC, tour de taille et transplantation rénale : contraintes, réalités et enjeux pour un centre spécialisé de l’obésité. Revue de la littérature. NUTR CLIN METAB 2020. [DOI: 10.1016/j.nupar.2020.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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16
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Laparoscopic Liver Transplantation: It's Time to Call for the Red Team! Ann Surg 2020; 272:894-896. [PMID: 32889883 DOI: 10.1097/sla.0000000000004452] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Maheshwari R, Qadri SY, Rakhul LR, Chaturvedi S, Desai P, Grover R, Chhabra G, Khullar D, Kumar A. Prospective Nonrandomized Comparison Between Open and Robot-Assisted Kidney Transplantation: Analysis of Midterm Functional Outcomes. J Endourol 2020; 34:939-945. [PMID: 32600060 DOI: 10.1089/end.2020.0213] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Abstract
Introduction: To compare short- and midterm outcomes of the first 55 patients undergoing robot-assisted kidney transplant (RAKT) with patients undergoing open kidney transplant (OKT) during the same period in a tertiary care hospital. Materials and Methods: Data of all end-stage renal disease patients undergoing renal transplant were prospectively maintained. All graft kidneys were harvested laparoscopically. Both RAKT and OKT were performed using standardized techniques, and all RAKTs were performed by a single experienced robotic surgeon. Chi-square test/Fisher exact test was done for categorical data, and Mann-Whitney U test was done for continuous data. Discrete variables were expressed in absolute numbers and percentages. For all tests, p < 0.05 was considered significant. All results were expressed as mean ± standard deviation or median with range. Results: Between April 2016 and September 2018, 55 patients underwent RAKT. The same was compared with 152 patients who underwent OKT. The two groups were comparable in terms of age, gender, and body mass index. Duration on hemodialysis was significantly higher in the RAKT group, and hemoglobin and donor kidney glomerular filtration rate was significantly better in the RAKT group. Requirement of perioperative analgesia was significantly less in the RAKT group. Rewarm ischemia time was significantly longer in the RAKT group. The fall in serum creatinine was slower in RAKT group till 3 months. The serum creatinine levels were statistically similar in the two cohorts at 3 months (p = 0.082), which was maintained at median 29 months of follow-up (p = 0.067). Tacrolimus levels on postoperative day 2 were found to be significantly higher in RAKT cohort (17.98 ± 14.41) vs OKT cohort (11.38 ± 6.93). Surgical-site infections were rare in the RAKT group. Conclusions: RAKT confers advantage of decreased wound morbidity with similar functional outcomes compared with OKT in midterm. It looks promising; however, long-term follow-up of larger numbers of patients is needed.
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Affiliation(s)
- R Maheshwari
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Y Qadri
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - L R Rakhul
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - S Chaturvedi
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - P Desai
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
| | - R Grover
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - G Chhabra
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - D Khullar
- Department of Nephrology and Transplant Medicine, Max Super Speciality Hospital, Saket, New Delhi, India
| | - A Kumar
- Department of Urology, Kidney Transplantation, Robotics and Uro-oncology and Max Super Speciality Hospital, Saket, New Delhi, India
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18
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Yao J, Laurence J, Hameed A, Lee T, Allen R, Pleass H, Yuen L, Lam V, Leslie S, Kim L, Lau H. How to do it: a robotic kidney autotransplant. ANZ J Surg 2020; 90:1472-1473. [PMID: 32356606 DOI: 10.1111/ans.15936] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2019] [Revised: 02/26/2020] [Accepted: 04/06/2020] [Indexed: 11/28/2022]
Abstract
We describe Australia's first reported case of robotic kidney autotransplantation for a complex renal artery aneurysm. It is potentially a safe, minimally invasive method of salvaging renal parenchyma and preservation of renal function in patients with complex renovascular conditions. This technique shows promise in carefully selected patients performed in centres with surgeons experienced in both kidney transplantation and the robotic platform.
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Affiliation(s)
- Jinna Yao
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney Medical School, Sydney, New South Wales, Australia
| | - Jerome Laurence
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney Medical School, Sydney, New South Wales, Australia.,Department of Surgery, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Ahmer Hameed
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney Medical School, Sydney, New South Wales, Australia
| | - Taina Lee
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney Medical School, Sydney, New South Wales, Australia
| | - Richard Allen
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney Medical School, Sydney, New South Wales, Australia
| | - Henry Pleass
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Sydney Medical School, Sydney, New South Wales, Australia
| | - Lawrence Yuen
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia
| | - Vincent Lam
- National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, Macquarie University, Sydney, New South Wales, Australia
| | - Scott Leslie
- Department of Urology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia
| | - Lawrence Kim
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia
| | - Howard Lau
- Department of Urology, Westmead Hospital, Sydney, New South Wales, Australia.,National Pancreas Transplant Unit, Westmead Hospital, Sydney, New South Wales, Australia.,Discipline of Surgery, University of Western Sydney Medical School, Sydney, New South Wales, Australia
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19
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Kovács G, Devercelli G, Zelei T, Hirji I, Vokó Z, Keown PA. Association between transplant glomerulopathy and graft outcomes following kidney transplantation: A meta-analysis. PLoS One 2020; 15:e0231646. [PMID: 32343692 PMCID: PMC7188300 DOI: 10.1371/journal.pone.0231646] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 03/28/2020] [Indexed: 02/07/2023] Open
Abstract
Transplant glomerulopathy (TG), a morphological lesion associated with confluent mechanisms of endothelial injury of renal allografts, may provide a viable predictor of graft failure. This systematic literature review and meta-analysis were performed according to the PRISMA statement to examine evidence describing the association between TG and graft loss or failure and time to these events. The literature review was conducted using the Scopus, EBSCO, and Cochrane Library search engines. Hazard ratios, median survival times, and 95% confidence intervals (CIs) were estimated to evaluate graft survival in the total population and prespecified subgroups. Meta-regression analysis assessed heterogeneity. Twenty-one publications comprising 6,783 patients were eligible for data extraction and inclusion in the meta-analysis. Studies were highly heterogeneous (I2 = 67.3%). The combined hazard ratio of graft loss or failure from random-effects meta-analysis was 3.11 (95% CI 2.44–3.96) in patients with TG compared with those without. Median graft survival in patients with TG was 3.25 (95% CI 0.94–11.21) years—15 years shorter than in those without TG (18.82 [95% CI 10.03–35.32] years). The effect of time from transplantation to biopsy on graft outcomes did not reach statistical significance (p = 0.116). TG was associated with a threefold increase in the risk of graft loss or failure and a 15-year loss in graft survival, indicating viability as a surrogate measure for both clinical practice and studies designed to prevent or reverse antibody-mediated rejection.
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Affiliation(s)
| | | | - Tamás Zelei
- Syreon Research Institute, Budapest, Hungary
| | - Ishan Hirji
- Shire, a Takeda company, Lexington, Massachusetts, United States of America
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Center for Health Technology Assessment, Semmelweis University, Budapest, Hungary
| | - Paul A. Keown
- Syreon Corporation, Vancouver, British Columbia, Canada
- University of British Columbia, Vancouver, British Columbia, Canada
- * E-mail:
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20
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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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21
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Abstract
During the past 5 years, the body of literature surrounding the utilization of three-dimensional (3D) printing in the field of urology has grown exponentially. Incentivized by work hour restrictions, patient safety initiatives, and inspired by technical advances in biomaterials and rapid printing strategies, this emerging, and fascinating area of research has begun to make headway into clinical practice. However, concerns about cost, limited understanding of the technical processes involved, and lack of its potential uses remain barriers to its widespread adoption. We examined existing published literature on how 3D printing technologies have been utilized in the field of Urology to enhance pre-operative planning, revitalize surgical training, and modernize patient education, with particular focus on, robotic surgery. To date, 3D-printed models have been used and studied most commonly in the preoperative planning for nephron-sparing surgeries during the treatment of renal masses, where the challenges of complex renal anatomy and benefits of reducing renal ischemic injury create the most intuitive value. Prostate models are the second most common, particularly in the planning of nerve-sparing procedures. Early studies have demonstrated sufficient realism and educational effectiveness. Subsequent studies demonstrated improved surgeon confidence, operative performance, and optimized patient outcomes including high levels of patient satisfaction. Realistic, accurate, and reasonably priced models can currently be generated within hours using standard desktop 3D printers. While primarily utilized as anatomic replicas of diseased organs that restore a sense of haptic feedback lost in robotic procedures, innovations in polymers, improvements in 3D printer host and modeling software, and upgrades in printer hardware allow this technology to serve as a comprehensive, interactive, simulation platform that can be a critical surgical decision making as well as an effective teaching tool. As Urologists continue to rapidly diversify and iterate upon this adaptive modality, the benefits in patient outcomes will likely outpace the diminishing drawbacks, and we may well see the next revolution in surgical education, robotic techniques, and personalized medicine concurrently.
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Affiliation(s)
- Ahmed E Ghazi
- University of Rochester Medical Center (URMC), Rochester, NY, USA
| | - Brett A Teplitz
- University of Rochester Medical Center (URMC), Rochester, NY, USA
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