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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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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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Zeuschner P, Friedersdorff F, Siemer S, Stöckle M. [Robot-assisted kidney transplantation-what is new?]. UROLOGIE (HEIDELBERG, GERMANY) 2024; 63:361-366. [PMID: 38378943 DOI: 10.1007/s00120-024-02293-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 01/30/2024] [Indexed: 02/22/2024]
Abstract
BACKGROUND The first robot-assisted kidney transplantation (RAKT) was conducted in 2010, and the first time in Germany in 2016. As more than 5 years have passed, current evidence, technological developments and the latest (German) experience are presented. OBJECTIVES The current evidence and experience of RAKT was investigated from an international and German perspective. MATERIALS AND METHODS In a systemic search, relevant publications were analyzed and compared with the experiences at a German urological transplant department. RESULTS From an international perspective, RAKT can now be considered a standard procedure at experienced departments, as more than 680 RAKT have been documented in Europe. The functional results are excellent with low complication rates and good mid- to long-term functional outcomes. Although RAKT was initially only performed with living organ donations, it has also been successfully conducted with cadaveric grafts. The surgical technique can be applied in challenging and complex situations, such as for arteriosclerotic recipient vessels or for kidney transplantations in children. Although RAKT is still not widely performed in Germany, the university hospital in Marburg, the third urological department in Germany, has successfully initiated a robotic transplant program. CONCLUSIONS Compared to open kidney transplantation, robot-assisted kidney transplantation enables at least noninferior results. It further appears to translate the well-documented advantages of minimally invasive surgery to kidney transplantation. However, its spread throughout Germany is only slowly increasing, possibly because only a handful of urological departments still perform kidney transplantations.
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Affiliation(s)
- Philip Zeuschner
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland.
| | - Frank Friedersdorff
- Klinik für Urologie, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Deutschland
| | - Stefan Siemer
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland
| | - Michael Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes, Kirrberger Str. 100, 66421, Homburg/Saar, Deutschland
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Campi R, Pecoraro A, Piramide F, Gallo ML, Serni S, Mottrie A, Territo A, Decaestecker K, Breda A. The ERUS course on robot-assisted kidney transplantation. World J Urol 2024; 42:205. [PMID: 38554210 PMCID: PMC10981625 DOI: 10.1007/s00345-024-04802-y] [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: 11/18/2023] [Accepted: 01/16/2024] [Indexed: 04/01/2024] Open
Abstract
PURPOSE Robot-assisted kidney transplantation (RAKT) is being increasingly performed at selected referral institutions worldwide. Yet, surgical training in RAKT is still unstructured and not grounded into formal credentialing courses including simulation, lab facilities, and modular training with animal models. As such, developing standardized, modular training programs is warranted to provide surgeons with the RAKT-specific skillset needed for a "safe" learning curve. METHODS The 3-day course on RAKT developed at the EAU Skills Center in Orsi Academy was designed as a standardized, modular, step-by-step approach aiming to provide theoretical and practical skills. The course is held by expert proctors with extensive experience in RAKT. To maximize the course's usefulness, a solid knowledge of robotics and transplantation is desirable for participants. RESULTS From January 2016 to July 2023, 87 surgeons from 23 countries (of which 36% from extra-European countries) participated in the RAKT course performed at the EAU Skills Center in Orsi Academy. Of these, 58/87 (67%) were urologists, while 27/87 (31%) were general surgeons and 2/87 (2%) were vascular surgeons. To date, 18 participants (20.6%) are actively involved in RAKT programs at institutions included in the European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT network. CONCLUSION Leveraging the potential of simulation, wet-lab training, live porcine models, and experienced proctors, the RAKT course performed at the EAU Skills Center in Orsi Academy represents the first structured teaching effort aiming to offer surgeons a full immersion in RAKT to train the core technical skills.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy.
- Chirurgia Urologica Robotica Mini-Invasiva e dei Trapianti Renali, Azienda Ospedaliero-Universitaria Careggi, Viale San Luca, 50134, Florence, Italy.
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Federico Piramide
- Departement of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Turin, Italy
| | - Maria Lucia Gallo
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Largo Brambilla, 3, 50134, Florence, Italy
| | - Alex Mottrie
- Departement of Urology, Onze-Lieve-Vrouwziekenhuis Hospital, Aalst, Belgium
- ORSI Academy, Ghent, Belgium
| | - Angelo Territo
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Karel Decaestecker
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent, Belgium
- Department of Urology, AZ Maria Middelares Hospital, Ghent, Belgium
| | - Alberto Breda
- Department of Urology, Fundaciò Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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Pecoraro A, Territo A, Boissier R, Hevia V, Prudhomme T, Piana A, Bañuelos Marco B, Gallagher AG, Serni S, Decaestecker K, Breda A, Campi R. Proposal of a standardized training curriculum for open and robot-assisted kidney transplantation. Minerva Urol Nephrol 2024; 76:110-115. [PMID: 38426425 DOI: 10.23736/s2724-6051.23.05650-1] [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: 03/02/2024]
Abstract
Standardized training programs for open (OKT) and robot-assisted kidney transplantation (RAKT) remain unmet clinical needs. To fill this gap, we designed a modified Delphi Consensus aiming to propose the first structured surgical curricula for both OKT and RAKT, involving a multispecialty international panel of experts. Two web-based surveys were built drafting two separate series of statements (for OKT and RAKT, respectively). The two surveys were delivered to a panel of 63 experts (for OKT) and 21 experts (for RAKT), selected considering their experience, academic profile and involvement in international associations. Consensus was defined as ≥75% agreement between the responders. Overall, 25/63 (40%) and 14/21 (67%) participated in the first round of the Delphi Consensus for the development of the structured curriculum for OKT and RAKT, respectively. During the second round, the experts reached consensus on all statements, as well as on the domains composing the structure of the training pathway: 1) eligibility criteria for trainees and host centres; 2) theoretical training; 3) simulation; 4) real case observation; and 5) modular training in the operating theatre. To the best of our knowledge, this is the first proposal of a dedicated curriculum for OKT and RAKT grounded on insights from international experts of different specialties. Our proposed curriculum provides the foundation to standardize the education and training in KT across Europe and beyond.
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Affiliation(s)
- Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- European Robotic Urology Section (ERUS), European Association of Urology (EAU), Robot-Assisted Kidney Transplantation (RAKT) Working Group, Arnhem, the Netherlands
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Department of Urology, Instituto Ramón y Cajal de Investigación Sanitaria (IRYCIS), Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Alberto Piana
- Division of Urology, Department of Oncology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, 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
| | - Karel Decaestecker
- European Robotic Urology Section (ERUS), European Association of Urology (EAU), Robot-Assisted Kidney Transplantation (RAKT) Working Group, Arnhem, the Netherlands
- Department of Urology, University Hospital of Ghent, Ghent, Belgium
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
- European Robotic Urology Section (ERUS), European Association of Urology (EAU), Robot-Assisted Kidney Transplantation (RAKT) Working Group, Arnhem, the Netherlands
| | - 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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Reimold P, Aksoy C, Beckmann J, Zacharis A, Groeben C, Karschuck P, Eisenmenger N, Geks J, Huber J, Flegar L. Development and outcomes of surgical and urological kidney transplantation programs in Germany: a total population analysis from 2006 to 2021. World J Urol 2024; 42:65. [PMID: 38300367 PMCID: PMC10834564 DOI: 10.1007/s00345-023-04740-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 11/08/2023] [Indexed: 02/02/2024] Open
Abstract
PURPOSE Kidney transplantation (KT) is the most frequently performed organ transplantation. In Germany, KT is performed in urology and surgery departments with unknown consequences of this parallel structure. The aim of the study was to compare the development and outcome of KT in urology and surgery departments. METHODS On an institutional level, we analyzed the annual caseload from 2006 to 2021 with the reimbursement. INFO tool based on hospitals' quality reports (Reimbursement Institute, Hürth, Germany). For outcome comparison we extracted raw data from the transplantation centers' quality reports (Deutsche Stiftung Organtransplantation, DSO). RESULTS A total of 23,599 cases (17,781 deceased donor and 5,818 living donor KTs) were included. The total number of KTs decreased from 1851 in 2006 to 1701 in 2021 (- 8%; p = 0.12). The total number of urological KTs decreased from 592 cases in 2006 to 395 cases in 2021 (- 33.3%; p = 0.01). Further analysis revealed no significant differences between intra- and postoperative complications and graft quality at one year for deceased donor KTs (DDKT) although differences in immediate renal function and graft quality at discharge could be observed. There were no significant differences in immediate renal function and graft quality at discharge for living donor KTs (LDKT) between the specialties. CONCLUSION KTs performed in urology departments declined between 2006 and 2021. Nevertheless, intra- and postoperative complications as well as long-term function did not differ between surgical and urological KT programs. Hence, an interdisciplinary approach, especially considering the upcoming challenges in KT as, e.g., robot-assisted surgery seems reasonable.
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Affiliation(s)
- Philipp Reimold
- Department of Urology, Philipps-University Marburg, Marburg, Germany.
| | - Cem Aksoy
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Jonas Beckmann
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Christer Groeben
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Philipp Karschuck
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | | | - Josef Geks
- Department of Surgery, Philipps-University Marburg, Marburg, Germany
| | - Johannes Huber
- Department of Urology, Philipps-University Marburg, Marburg, Germany
| | - Luka Flegar
- Department of Urology, Philipps-University Marburg, Marburg, Germany
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Kishore TA, Kaddu DJ, Sodhi BS, Srinivasan SP, Unni NV. Robotic Kidney Transplant Beyond the Learning Curve: 8-Year Single-center Experience and Matched Comparison With Open Kidney Transplant. Urology 2024; 183:100-105. [PMID: 37952604 DOI: 10.1016/j.urology.2023.10.031] [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: 07/12/2023] [Revised: 10/01/2023] [Accepted: 10/16/2023] [Indexed: 11/14/2023]
Abstract
OBJECTIVE To investigate the medium to long-term outcomes of robotic-assisted kidney transplantation (RAKT) and propensity-matched comparison with open kidney transplant (OKT). MATERIALS AND METHODS We retrospectively reviewed 342 patients from database, who underwent RAKT and OKT from January 2015 to May 2022, at our center. Various demographic, intraoperative, and postoperative parameters were evaluated. Statistical analysis including propensity matching using nearest neighbor algorithm was performed to ensure comparability between the RAKT and OKT groups. The statistical analyses were performed using SPSS v.22.0 (IBM Corp, Armonk, NY) and STATA 13 (Stata Corp, College Station, TX). All statistical tests were two-sided, and a significance level of P < .05 was considered statistically significant. RESULTS After applying exclusion criteria, 196 RAKT patients and 102 OKT patients were included in the analysis. Propensity score matching resulted in the inclusion of 173 patients in the RAKT group. In the propensity-matched comparison of intra/perioperative parameters, RAKT showed significant reductions in total surgical time (P < .001), wound length (P < .001), blood loss (P < .001), blood transfusion rate (P < .001), pain score (P < .001), and analgesia requirement (P < .001). Graft survival and patient survival rates were comparable in RAKT and OKT groups at the end of 60months. CONCLUSION RAKT offers several advantages over OKT in terms of reduced operative time, blood loss, pain, and analgesia requirements. RAKT shows comparable graft and patient survival rates to OKT in the medium to long term.
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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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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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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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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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12
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Campi R, Pecoraro A, Sessa F, Vignolini G, Caroti L, Lazzeri C, Peris A, Serni S, Li Marzi V. Outcomes of kidney transplantation from uncontrolled donors after circulatory death vs. expanded-criteria or standard-criteria donors after brain death at an Italian Academic Center: a prospective observational study. Minerva Urol Nephrol 2023; 75:329-342. [PMID: 36946717 DOI: 10.23736/s2724-6051.23.05098-x] [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: 03/23/2023]
Abstract
BACKGROUND The use of kidneys from "expanded criteria" donors after brain death (ECD) and uncontrolled donors after circulatory death (uDCD) has been warranted to increase the pool of donors for kidney transplantation (KT). However, there is lack of evidence on the feasibility and safety of KT from such donors in the Italian setting. METHODS We queried our prospectively KT database to select patients undergoing KT from deceased donors (uDCDs, ECDs, and standard-criteria donors [SCD] after brain death) from January 2017 to December 2020, comparing the perioperative and mid-term functional outcomes. RESULTS Overall, 172 KTs were included. The donor's profile was different among the study groups, while recipients' characteristics were similar expect for median age. Grafts from uDCDs and ECDs had longer median cold ischemia times as compared to grafts from SCDs. The proportion of patients experiencing DGF, the median hospitalization, as well as the overall and major complications rate, were significantly higher among recipients from uDCDs. The proportion of patients needing dialysis at last follow-up was significantly higher among recipients from uDCDs (33.3% vs. 8.5% vs. 5.4%, P<0.001). However, the median eGFR at the last follow-up was lower for recipients from ECDs compared to those from uDCDs and SCDs, respectively (P<0.001). CONCLUSIONS While "marginal" donors represent a relevant source of organs, KTs from uDCDs carry higher risks of major surgical complications, DGF, and worse graft survival as compared to KT from both ECDs and SCDs. As such, the use of grafts from uDCDs should be carefully assessed balancing the potential benefits with the risk of primary no function and the subsequent immunological sensitization.
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Affiliation(s)
- Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University 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 University Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
| | - Leonardo Caroti
- Unit of Nephrology, Dialysis and Transplant, Careggi University Hospital, Florence, Italy
| | - Chiara Lazzeri
- Regional and Intensive Care Unit, ECMO Referral Center, Careggi University Hospital, Florence, Italy
| | - Adriano Peris
- Regional and Intensive Care Unit, ECMO Referral Center, Careggi University Hospital, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi University Hospital, University of Florence, Florence, Italy
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Andras I, Pecoraro A, Piana A, Prudhomme T, Campi R, Hevia V, Boissier R, Crisan N, Breda A, Territo A. Aims and limits to compare open vs. robotic assisted kidney transplantation. Actas Urol Esp 2023; 47:193-194. [PMID: 36372359 DOI: 10.1016/j.acuroe.2022.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2022] [Accepted: 10/11/2022] [Indexed: 05/05/2023]
Affiliation(s)
- I Andras
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania.
| | - A Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - A Piana
- Department of Urology, San Luigi Gonzaga Hospital, Univerity of Turin, Orbassano, Turin, Italy
| | - T Prudhomme
- Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
| | - R 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
| | - V Hevia
- Hospital Universitario Ramón y Cajal, Alcala University, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
| | - R Boissier
- Service de Chirurgie Urologique et de Transplantation Renale, CHU Conception, Aix-Marseille Universite, Marseille, France
| | - N Crisan
- Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania; Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania
| | - A Breda
- Departement of Urology, Fundacio Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - A Territo
- Departement of Urology, Fundacio Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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Andras I, Pecoraro A, Piana A, Prudhomme T, Campi R, Hevia V, Boissier R, Crisan N, Breda A, Territo A. Objetivos y limitaciones al comparar el trasplante renal abierto frente al asistido por robot. Actas Urol Esp 2023. [DOI: 10.1016/j.acuro.2022.10.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
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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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Piana A, Gallioli A, Amparore D, Diana P, Territo A, Campi R, Gaya JM, Guirado L, Checcucci E, Bellin A, Palou J, Serni S, Porpiglia F, Breda A. Three-dimensional Augmented Reality-guided Robotic-assisted Kidney Transplantation: Breaking the Limit of Atheromatic Plaques. Eur Urol 2022; 82:419-426. [PMID: 35985902 DOI: 10.1016/j.eururo.2022.07.003] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2022] [Revised: 06/15/2022] [Accepted: 07/11/2022] [Indexed: 12/15/2022]
Abstract
BACKGROUND Robotic-assisted kidney transplantation (RAKT) has shown solid results as a minimally invasive alternative to the standard open approach (open kidney transplantation [OKT]). However, RAKT is still limited in those cases where the recipient's iliac vessels present atherosclerotic plaques, frequently found in elder patients and in those subjected to long-term hemodialysis. Unlike OKT, where the surgeon can palpate the arterial plaques, in minimally invasive surgery the haptic feedback is missing, making the vascular clamping and arteriotomy unsafe. OBJECTIVE To employ three-dimensional (3D) imaging reconstruction using augmented reality (AR) to intraoperatively locate the plaques during the crucial steps of kidney transplantation. DESIGN, SETTING, AND PARTICIPANTS Our study was conducted according to the Idea, Development, Exploration, Assessment, and Long-term follow-up (IDEAL) model for surgical innovation. Three-dimensional virtual models were obtained from high-accuracy computed tomography scan imaging and superimposed on the vessels during RAKT using the Da Vinci console software. SURGICAL PROCEDURE Three-dimensional AR-guided robotic-assisted kidney transplantation. MEASUREMENTS The correspondence of virtual models with the real anatomy of patients was assessed comparing vessels' and plaques' measures. RESULTS AND LIMITATIONS We tested the possibility of using the AR in the setting of vascular surgery by checking the correspondence of the virtual models to the real vessels. During the accuracy assessment, we investigated the anatomy of the iliac plaques and the capacity of the virtual models to correctly represent them. Finally, we tested the efficacy of the virtual model superimposition on the real vessels with plaques during RAKT in the recipients of living donor grafts. The main limitation consists in training needed to correctly superimpose virtual models on the real field. CONCLUSIONS The employment of 3D AR allowed surgeons to overcome one of the main limitations of RAKT, setting the foundation to expand its indications to patients with advanced atheromatic vascular disease. PATIENT SUMMARY The use of three-dimensional augmented reality guidance during kidney transplantation (KT) has the potential to "navigate" the surgeon during KT, allowing a safer procedure in patients with atheromatic vascular disease.
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Affiliation(s)
- Alberto Piana
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain; Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Turin, Italy.
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Daniele Amparore
- Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Turin, Italy
| | - Pietro Diana
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Riccardo Campi
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Lluis Guirado
- Department of Nephrology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Enrico Checcucci
- Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Turin, Italy
| | - Andrea Bellin
- Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Turin, Italy
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Sergio Serni
- Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Porpiglia
- Department of Urology, "San Luigi Gonzaga" Hospital, University of Turin, Turin, Italy
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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Rajmohan N, Omkarappa S, Srinivasan SP, Nair SG, Rajgopal R, Eldo N. Anesthetic Challenges and Perioperative Factors Affecting Delayed Graft Function in Robotic-Assisted Kidney Transplant: A Review of a Single-Center Experience of 100 Cases. Cureus 2022; 14:e28957. [PMID: 36237794 PMCID: PMC9547721 DOI: 10.7759/cureus.28957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/24/2022] [Indexed: 11/05/2022] Open
Abstract
Background and objective The advent of robot-assisted kidney transplant (RAKT) has ushered in a new set of challenges. In this single-center retrospective observational study, we aimed to highlight the anesthetic challenges and analyze perioperative parameters to identify the risk factors for delayed graft function (DGF) in RAKT. Methods A descriptive analysis of perioperative factors of the first 100 cases of RAKT at our center was performed. Data were retrieved from the hospital's electronic medical records (EMR) of donors and adult patients who underwent RAKT between July 2015 and December 2020. The data analyzed included demographics, preoperative optimization, intraoperative and postoperative management, and complications. DGF was defined as a requirement of dialysis within one week of transplant. The Fisher’s exact test, independent sample t-test, and the Mann-Whitney test were used to analyze data. Results Among a total of 193 renal transplants performed during the study period, 100 patients underwent RAKT, which included 27 females and 73 males. Of these, 91 were live while the remaining involved deceased-donor transplants. Pneumoperitoneum and steep Trendelenburg position required various “anesthetic maneuvers” to maintain hemodynamics and respiratory parameters. Optimal fluid management, with frusemide and mannitol, ensured good urine output (UOP) (93%). Post-reperfusion, the release of pneumoperitoneum, maintenance of adequate perfusion pressures, immunosuppression, and regional hypothermia helped in ensuring adequate graft function (93%). The incidence of DGF in our series was 7% and the mortality rate was 3%. Recipient age (p=0.045), dyslipidemia (p=0.021), and diabetes mellitus (p=0.023) were identified as significant risk factors for DGF. Conclusion Advanced recipient age, diabetes, and dyslipidemia were factors significantly associated with DGF in RAKT in our series of 100 cases. However, the duration of the steep Trendelenburg position, docking of robot/pneumoperitoneum (console time), fluid management, warm and cold ischemia times, rewarming time, and type of graft did not influence DGF. Awareness of the systemic involvement in RAKT, proper preoperative optimization, and knowledge of potential problems are essential for the efficient anesthetic management of RAKT.
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Single port robot-assisted kidney transplantation: Extraperitoneal approach. UROLOGY VIDEO JOURNAL 2022. [DOI: 10.1016/j.urolvj.2022.100177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
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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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Pecoraro A, Li Marzi V, Sessa F, Boissier R, Hevia V, Prudhomme T, Andras I, Breda A, Serni S, Territo A, Campi R. Urologists and Kidney Transplantation: The First European Census. Eur Urol 2022; 82:336-337. [PMID: 35717360 DOI: 10.1016/j.eururo.2022.05.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2022] [Revised: 05/19/2022] [Accepted: 05/31/2022] [Indexed: 11/04/2022]
Affiliation(s)
- 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
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
| | - Romain Boissier
- Department of Urology and Renal Transplantation, La Conception University Hospital, Marseille, France
| | - Vital Hevia
- Urology Department, Hospital Ramón y Cajal, Instituto Ramón y Cajal de Investigación Sanitaria, Alcalá University, Madrid, Spain
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Iulia Andras
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - 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
| | - Angelo Territo
- Department of Urology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - 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.
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Piana A, Andras I, Diana P, Verri P, Gallioli A, Campi R, Prudhomme T, Hevia V, Boissier R, Breda A, Territo A. Small renal masses in kidney transplantation: overview of clinical impact and management in donors and recipients. Asian J Urol 2022; 9:208-214. [PMID: 36035353 PMCID: PMC9399547 DOI: 10.1016/j.ajur.2022.06.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 03/24/2022] [Accepted: 04/19/2022] [Indexed: 11/26/2022] Open
Abstract
Kidney transplantation is the best replacement treatment for the end-stage renal disease. Currently, the imbalance between the number of patients on a transplant list and the number of organs available constitutes the crucial limitation of this approach. To expand the pool of organs amenable for transplantation, kidneys coming from older patients have been employed; however, the combination of these organs in conjunction with the chronic use of immunosuppressive therapy increases the risk of incidence of graft small renal tumors. This narrative review aims to provide the state of the art on the clinical impact and management of incidentally diagnosed small renal tumors in either donors or recipients. According to the most updated evidence, the use of grafts with a small renal mass, after bench table tumor excision, may be considered a safe option for high-risk patients in hemodialysis. On the other hand, an early small renal mass finding on periodic ultrasound-evaluation in the graft should allow to perform a conservative treatment in order to preserve renal function. Finally, in case of a renal tumor in native kidney, a radical nephrectomy is usually recommended.
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22
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St Jules R, Blech D, Smith NK, Sakai T. Abdominal Organ Transplantation: Noteworthy Literature in 2021. Semin Cardiothorac Vasc Anesth 2022; 26:140-153. [PMID: 35608409 DOI: 10.1177/10892532221093955] [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] [Indexed: 11/15/2022]
Abstract
This review highlights noteworthy literature pertinent to anesthesiologists and critical care physicians caring for patients undergoing abdominal organ transplantation. In 2021, we identified noteworthy papers from over 1,200 peer-reviewed publications on pancreatic transplantation, over 1,400 on intestinal transplantation, and over 9,000 on kidney transplantation. The liver transplantation section focuses on clinical trials and systematic reviews and meta-analyses published in 2021 and features 20 selected papers. COVID-19 and abdominal organ transplantation are featured in an independent section.
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Affiliation(s)
- Robert St Jules
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Daniel Blech
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Natalie K Smith
- Department of Anesthesiology, Perioperative and Pain Medicine, The Icahn School of Medicine at Mount Sinai Hospital, New York, NY, USA
| | - Tetsuro Sakai
- Department of Anesthesiology and Perioperative Medicine, UPMC (University of Pittsburgh Medical Center), Pittsburgh, PA, USA
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23
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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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24
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Dobrijevic ELK, Au EHK, Rogers NM, Clayton PA, Wong G, Allen RDM. Association Between Side of Living Kidney Donation and Post-Transplant Outcomes. Transpl Int 2022; 35:10117. [PMID: 35444489 PMCID: PMC9013757 DOI: 10.3389/ti.2022.10117] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 03/03/2022] [Indexed: 11/13/2022]
Abstract
Background: Right-sided living donor kidneys have longer renal arteries and shorter veins that make vascular anastomosis more challenging. We sought to determine whether recipients of right-sided living donor kidneys have worse outcomes than left-sided kidney recipients. Methods: An observational analysis of the Australia and New Zealand Dialysis and Transplant Registry (ANZDATA) was undertaken. We used adjusted logistic regression to determine the association between side and delayed graft function (DGF) and time-stratified adjusted cox regression models for graft and patient survivals. Results: Between 2004 and 2018, 4,050 living donor kidney transplants were conducted with 696 (17.2%) using right kidneys. With reference to left kidneys, the adjusted OR (95% CI) for DGF was 2.01 (1.31–3.09) for recipients with right kidneys. Within 30 days, 46 allografts (1.4%) were lost, with major causes of overall graft loss being technical, primary non-function and death. Recipients of right donor kidneys experienced a greater risk of early graft loss (aHR 2.02 [95% CI 1.06–3.86], p = 0.03), but not beyond 30 days (aHR 0.97 [95% CI 0.80–1.19], p = 0.8]). Conclusion: Technical challenge is the most common cause of early graft loss. The risk of early graft loss among recipients who received right kidneys is doubled compared to those who received left living donor kidneys.
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Affiliation(s)
| | - Eric H K Au
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia
| | - Natasha M Rogers
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia.,Department of Renal and Transplant Medicine, Westmead Hospital, Westmead, NSW, Australia.,Starzl Transplant Institute, University of Pittsburgh, Pittsburgh, PA, United States
| | - Philip A Clayton
- Central and Northern Adelaide Renal and Transplantation Services, Adelaide, SA, Australia.,Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry, Adelaide, SA, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, SA, Australia
| | - Germaine Wong
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia.,Department of Renal and Transplant Medicine, Westmead Hospital, Westmead, NSW, Australia
| | - Richard D M Allen
- Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,The Centre for Transplant and Renal Research, Westmead Institute of Medical Research, Westmead, NSW, Australia.,Department of Transplantation Surgery, Westmead Hospital, Westmead, NSW, Australia
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25
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Territo A, Boissier R, Subiela JD, Gallioli A, Meneghetti I, Theil G, Regis F, Mohammed N, Fornara P, Gausa L, Guirado L, Breda A. Prospective comparative study of postoperative systemic inflammatory syndrome in robot-assisted vs. open kidney transplantation. World J Urol 2021; 40:2153-2159. [PMID: 34657175 DOI: 10.1007/s00345-021-03836-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Accepted: 09/09/2021] [Indexed: 12/30/2022] Open
Abstract
PURPOSE Robot-assisted kidney transplant (RAKT) recently proved to provide functional results similar to the preferred open kidney transplant (OKT), but with inferior wound morbidity. In a comparative prospective study, we explored the systemic inflammatory response syndrome (SIRS) after KT and compared OKT with RAKT. METHODS Forty-nine patients underwent pre-emptive ABO-compatible kidney transplantations (KT) between January 2017 and December 2018 in 2 centers: 25 RAKT, 24 OKT. Postoperative SIRS was biologically assessed by serum markers (NGAL, CRP and IL-6) measured at: T0 (preoperative/baseline), T1(H1), T2(H6), T3(H12), T4(H24), T5(D2), T6(D3) and T7(D5) after KT. RESULTS Inflammatory markers + eGFR were assessed in OKT vs. RAKT. IL-6 peak value occurred at H6 and reached ×9 from baseline. CRP peak occurred at H24 and reached ×28 from baseline (All P < 0.05). NGAL decreased after surgery with a plateau (divided by 2 from baseline) from H12 to D5. There was no significant difference in IL-6, CRP and NGAL kinetics and peak values between RAKT and OKT (All P > 0.05). Serum creatinine and eGFR on postoperative days 1, 3 and 7 were similar in RAKT and OKT (All P > 0.05). Delayed graft function was not observed. CONCLUSION In this exploratory study, the biological evaluation of postoperative SIRS after living-donor kidney transplant revealed no significant difference between OKT and RAKT and similar functional outcomes in the short term. These results highlight the safety of RAKT as an alternative to OKT in this setting.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Romain Boissier
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
| | - Jose Daniel Subiela
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Andrea Gallioli
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Iacopo Meneghetti
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Gerit Theil
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Federica Regis
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Nasreldin Mohammed
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Paolo Fornara
- Department of Urology, University Hospital Halle (Saale), Halle, Germany
| | - Lluis Gausa
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Lluis Guirado
- Department of Nephrology Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
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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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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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28
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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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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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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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Zhu X, Zhao Y, Han X, Li Y, Zhang P, Wang S, Li G, Xiang C. Extraperitoneal Laparoscopic Kidney Transplantation: Preliminary Clinical Experiences from China. Adv Ther 2021; 38:1677-1689. [PMID: 33580484 DOI: 10.1007/s12325-021-01639-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 01/27/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To report on the pioneering clinical experiences of six cases of extraperitoneal laparoscopic kidney transplantation in China. METHODS For the first time in clinical practice, a customised, controllable double-circulation cooling device was used to protect the transplanted kidney. Of the six patients, two underwent an allograft renal transplantation because they had been diagnosed with uraemia and were on maintenance haemodialysis. The other four patients underwent kidney autotransplantation because of a central renal tumour. RESULTS The extraperitoneal laparoscopic kidney transplantations were successfully completed between 2017 and 2018. The operative time for the two patients undergoing the allograft transplantation was 3-3.5 h. The time for venous anastomosis was approximately 53-65 min, and the time for arterial anastomosis was approximately 25-30 min. The creatinine level was 90-80 μmol/L after surgery. The operative time of the four patients who underwent autotransplantation was 9.4-17.5 h. The times of venous and arterial anastomosis were 58-90 min and 35-48 min, respectively. The follow-up B-mode ultrasound after surgery showed good blood supply in the spared nephron. A renal graft was removed from one patient 6 months after surgery because of renal atrophy and dysfunction caused by poor blood supply. Five patients (two undergoing allografting and three undergoing autografting) completed the 12-month follow-up, and their renal graft function was good. CONCLUSIONS Extraperitoneal laparoscopic kidney transplantation, either allograft or autologous transplantation, is a safe and feasible procedure with a good chance of survival for the transplanted kidney. A customised cooling device is effective and practical during laparoscopic kidney transplantation.
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Affiliation(s)
- Xuhui Zhu
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Yongwei Zhao
- Department of Urology, Taian City Central Hospital, Taian, 271000, Shangdong, People's Republic of China
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, People's Republic of China
| | - Xiuwu Han
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China.
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China.
| | - Yansheng Li
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Peng Zhang
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Siyuan Wang
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Gao Li
- Institute of Urology, Capital Medical University, Beijing, People's Republic of China
- Department of Urology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, People's Republic of China
| | - Chunhong Xiang
- Department of Surgery and Anesthesiology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, 100043, People's Republic of China
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Branchereau J. Redefining the urologist's role in kidney transplantation. World J Urol 2020; 40:301-302. [PMID: 33175209 DOI: 10.1007/s00345-020-03520-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Accepted: 10/30/2020] [Indexed: 11/28/2022] Open
Affiliation(s)
- Julien Branchereau
- Department of Urology / Nantes University Hospital, CHU de Nantes, 1 place Alexis Ricordeau, 44093, Nantes, France.
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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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