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Kędzierska-Kapuza K, Łopuszyńska I, Mizerska A, Matejak-Górska M, Safranow K, Durlik M. Robotic-Assisted Nephrectomy for Living Kidney Donation-Single Center Initial Experience (Case Series) and Review of the Literature. J Clin Med 2024; 13:3754. [PMID: 38999324 PMCID: PMC11242777 DOI: 10.3390/jcm13133754] [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: 05/26/2024] [Revised: 06/16/2024] [Accepted: 06/19/2024] [Indexed: 07/14/2024] Open
Abstract
Background: Robotic-assisted nephrectomy for living kidney-donation (RANLD) has the potential of becoming the leading technique of harvesting kidney, if expertise is available. The aim of this work is to present our initial experience with robotic technique with additional hand-assistance. Materials and Methods: We initiated RANLD at our clinic using the DaVinci System in September 2022, since then harvesting six kidneys, four left and two right; in two cases, multiple arteries existed. The renal vessels were ligated using vascular staplers. All the operations included a hand-assist with the use of Gelport. The mean operation time was 119.2 min (SD 12 min). Results: There were no conversions or donors' post-operative complications. Time of discharge from the hospital was 4.5 days post-operatively. Total hospital length of stay was 7.8 days. All the harvested kidneys were transplanted, five of them with adequate function, three with initially delayed function, and one needed to be removed due to thrombotic complications. Post-operative was pain assessed on the VAS scale and overall pain was assessed according to the NRS scale. At the discharge day, donors' performance status was about 87.5% according to the Karnofsky scale. The donors resumed their normal life activity within 15.7 days and returned to work within 45.2 days. The serum mean creatinine level before the donation was 0.85 mg/dL (SD 0.1 mg/dL), and mean eGFR (MDRD) = 91.8 mL/min/1.73 m2 (SD 16.1 mL/min/1.73 m2). Conclusions: Further development of RANLD could lead to an increase in the number of living kidney donors, particularly in Poland where the number is currently lower than that of deceased donors. Prolonged operation time, longer warm ischemic time, and high equipment costs are significant drawbacks of RANLD.
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Affiliation(s)
- Karolina Kędzierska-Kapuza
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute, Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland
| | - Inga Łopuszyńska
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute, Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland
| | - Agnieszka Mizerska
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute, Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland
| | - Marta Matejak-Górska
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute, Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland
| | - Krzysztof Safranow
- Department of Biochemistry and Medical Chemistry, Pomeranian Medical University in Szczecin, Powstańców Wlkp. 72, 70-111 Szczecin, Poland
| | - Marek Durlik
- Department of Gastroenterological Surgery and Transplantology, National Medical Institute, Ministry of Interior Affairs and Administration, Wołoska St. 137, 02-507 Warsaw, Poland
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2
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Rowaiee R, Gholami M, Concepcion W, Vedayar H, Janahi F. Retroperitoneal robot-assisted live-donor nephrectomy: A single-center study. FRONTIERS IN TRANSPLANTATION 2023; 2:1062240. [PMID: 38993900 PMCID: PMC11235276 DOI: 10.3389/frtra.2023.1062240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/10/2023] [Indexed: 07/13/2024]
Abstract
Background As the demand for kidney transplants continues to increase globally, healthcare institutions face a challenge to bridge the gap between patients waitlisted for kidney transplants and the number of donors. A major factor influencing the donor's decision is the operative risk and potential complications of the surgery. Open surgical approaches have been vastly replaced with laparoscopic donor nephrectomies as the standard of practice. However, there is a growing body of evidence pointing towards its potential superiority over laparoscopic methods. In this study, we aim to present our experience on outcomes of Robotic-Assisted Live Donor Nephrectomies (RALDN), the first series of its kind in the United Arab Emirates (UAE). Methods We retrospectively collected data from patients who underwent RALDN at Mediclinc City Hospital. Demographic data, laboratory investigations, and operative details were collected and analyzed. Results Seven patients underwent RALDN between 2021 and April 2022 at our facility. Four donors were male while three were female. Median length of hospital stay was 4 days. In our study, one of the patients suffered from a Clavien-Dindo grade IV complication which necessitated prolonged admission. Conclusion We conclude that RALDN is a safe method for donor kidney procurement, carrying a low risk of morbidity and mortality. This method could potentially evolve the number of kidney donors to address the issue of high kidney transplant demand.
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Affiliation(s)
- Rashed Rowaiee
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Mandana Gholami
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Waldo Concepcion
- Department of General Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Hemant Vedayar
- Department of General Surgery, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
| | - Farhad Janahi
- College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Healthcare City, Dubai, United Arab Emirates
- Department of Urology, Mediclinic City Hospital, Dubai Healthcare City, Dubai, United Arab Emirates
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3
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Pelegrin T, Champy CM, Gerbaud F, Miro-Padovani M, Grimbert P, Matignon MB, Durrbach A, De La Taille A, Ingels A. Robotic-assisted laparoscopy living donor nephrectomy: Technique and results of a monocentric retrospective series. Prog Urol 2022; 32:567-576. [PMID: 35623941 DOI: 10.1016/j.purol.2022.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/09/2022] [Accepted: 03/21/2022] [Indexed: 10/18/2022]
Abstract
INTRODUCTION Robot-assisted nephrectomy for living kidney donation (LKD) has been described in the literature as a safe and reproducible technique in high volume centers with extensive robotic surgery experience. Any surgical procedure in a healthy individual ought to be safe in regards to complications. The objective of this study was to evaluate the Robotic-assisted Living Donor Nephrectomy (RLDN) experience in a robotic surgery expert center. METHODS This is a retrospective study from 11/2011 and 12/2019. In total, 118 consecutive Living Donor (LD) kidney transplants were performed at our institution. All the procedures were performed by robotic-assisted laparoscopic approach. Extraction was performed by iliac (IE), vaginal (VE) or umbilical extraction (UE). The left kidney was preferred even if the vascular anatomy was not modal. RESULTS For donors: the median operative time was 120min with 50mL of blood loss. The median warm ischemia time was 4min, with a non-significant shorter duration with the UE (4min) in comparison with IE or VE (5min). Nine patients had postoperative complications including 1 grade II (blood transfusion) and 1 grade IIIb (vaginal bleeding after VE). None of our procedures were converted to open surgeries and no deaths were reported. For the recipients: 1.7% presented delayed graft function; their median GFR at 1 year was 61mL/min/1.73m2. CONCLUSION RLDN in an expert center appears to be a safe technique. The advantages of the robot device in terms of ergonomy don't hamper the surgical outcomes. Donor, recipient and graft survivals seem comparable to the reported laparoscopic outcomes in the literature. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- T Pelegrin
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France.
| | - C M Champy
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - F Gerbaud
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - M Miro-Padovani
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - P Grimbert
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - M-B Matignon
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A Durrbach
- Service de néphrologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A De La Taille
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
| | - A Ingels
- Service d'urologie, UPEC, hôpital Henri-Mondor, Créteil, France
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4
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Robotic-assisted Versus Open Technique for Living Donor Kidney Transplantation: A Comparison Using Propensity Score Matching for Intention to Treat. Transplant Direct 2022; 8:e1320. [PMID: 35434284 PMCID: PMC9005261 DOI: 10.1097/txd.0000000000001320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 01/22/2022] [Indexed: 11/26/2022] Open
Abstract
Living donor robotic-assisted kidney transplantation (RAKT) is an alternative to open kidney transplantation (OKT), but experience with this technique is limited in the United States.
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5
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Thai MS, Chau QT, Hoang KC, Ngo XT, Tran TT, Nguyen TH, Thai KL, Vu DH, Dinh LQV, Pham DM, Tiong HY, Nguyen TT. Introducing robot-assisted laparoscopic donor nephrectomy after experience in retroperitoneal endoscopic approach: a matched propensity score analysis. ANZ J Surg 2021; 92:531-537. [PMID: 34927326 DOI: 10.1111/ans.17424] [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: 07/15/2021] [Revised: 11/11/2021] [Accepted: 12/06/2021] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To assess the safety and efficacy of introducing robotic-assisted laparoscopic donor nephrectomy (RALDN) to the standard retroperitoneal endoscopic donor nephrectomy (REDN). METHODS Data were collected prospectively from 124 consecutive living kidney donors (93 for REDN subgroup and 31 for RALDN subgroup) from February 2018 to December 2020. Donor baseline demographics, perioperative outcomes and recipient outcomes were recorded, and these parameters were compared between the two subgroups before and after propensity-score matching. RESULTS Mean age was 51.1 ± 9.1 years; 42.7% were males; mean body mass index was 22.7 ± 2.4; and there were 109 (88%) left kidneys. The following data of REDN and RALDN was, respectively, recorded: operative time (213 ± 43 versus 216 ± 39 min, p = 0.721), warm ischemic time (4.7 ± 1.2 versus 4.9 ± 1.4 min, p = 0.399), postoperative complications (5.4% versus 6.5%, p = 1), haemoglobin (g/L) drop (9.4 ± 7.2 versus 9.7 ± 6.6, p = 0.836), blood creatinine at 6 month (1.15 ± 0.23 versus 1.13 ± 0.24 mg/dL, p = 0.734) and at 1 year (1.09 ± 0.22 versus 1.17 ± 0.28 mg/dL, p = 0.591). In post-propensity score matched analyses, there was no significant differences between the two groups including intraoperative and postoperative complications. CONCLUSIONS RALDN could be safely introduced into a living donor program experienced in laparoscopic donor nephrectomy. The outcomes of our study comparing these minimally invasive techniques are mostly similar in terms of intraoperative and postoperative outcomes for kidney donors.
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Affiliation(s)
- Minh Sam Thai
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Quy Thuan Chau
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Khac Chuan Hoang
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Xuan Thai Ngo
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Trong Tri Tran
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | | | - Kinh Luan Thai
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Duc Huy Vu
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam
| | - Le Quy Van Dinh
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Duc Minh Pham
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
| | - Ho Yee Tiong
- Urology Department, National University Hospital, Singapore
| | - Tuan Thanh Nguyen
- Urology Department, Cho Ray Hospital, Ho Chi Minh City, Viet Nam.,Urology Department, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Viet Nam
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Glatz T, Brinkmann S, Bausch D. [Robot-assisted Living Donor Nephrectomy - Technical Aspects and Initial Evidence]. Zentralbl Chir 2021; 146:400-406. [PMID: 33782928 DOI: 10.1055/a-1346-0304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Minimally invasive donor nephrectomy has become the standard procedure in most transplant centres over the past two decades and has contributed to a reduction in postoperative morbidity for the donor. Robot-assisted technology is an alternative to conventional (hand-assisted) laparoscopic technology and will find increasing use in the future. In this review article, we address technical aspects of robotic-assisted donor nephrectomy, in accordance with our own experience and will provide an overview of the currently available literature. Robot-assisted living kidney donation is a safe procedure with a very low postoperative complication rate. The procedure offers advantages over the open surgical technique with respect to the reduction in the postoperative need for analgesia and the duration of hospital stay, with longer operating times and warm ischemia times, but without a measurable effect on transplant function. The postoperative outcome parameters are comparable to those of the laparoscopic technique, indicating a further acceleration of postoperative convalescence. The advantages of robot-assisted technology, due to the better exposure options, are most relevant in patients with a high BMI and multiple renal arteries, as well as in right-sided nephrectomies in which a longer transplant artery can be obtained. Robot-assisted living kidney donation will play a major role in the future of transplant surgery and is a serious alternative to conventional laparoscopic technology.
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Affiliation(s)
- Torben Glatz
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Sebastian Brinkmann
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
| | - Dirk Bausch
- Chirurgische Klinik, Marien Hospital Herne - Universitätsklinikum der Ruhr-Universität Bochum, Herne, Deutschland
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7
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Serni S, Pecoraro A, Sessa F, Gemma L, Greco I, Barzaghi P, Grosso AA, Corti F, Mormile N, Spatafora P, Caroassai S, Berni A, Gacci M, Giancane S, Tuccio A, Sebastianelli A, Li Marzi V, Vignolini G, Campi R. Robot-Assisted Laparoscopic Living Donor Nephrectomy: The University of Florence Technique. Front Surg 2021; 7:588215. [PMID: 33521044 PMCID: PMC7844329 DOI: 10.3389/fsurg.2020.588215] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/16/2020] [Indexed: 12/11/2022] Open
Abstract
Objective: To provide a step-by-step overview of the University of Florence technique for robotic living donor nephrectomy (LDN), focusing on its technical nuances and perioperative outcomes. Methods: A dedicated robotic LDN program at our Institution was codified in 2012. Data from patients undergoing robotic LDN from 2012 to 2019 were prospectively collected. All robotic LDNs were performed by a highly experienced surgeon, using the da Vinci Si robotic platform in a three-arm configuration. In this report we provide a detailed overview of our surgical technique for robotic LDN. The main objective of the study was to evaluate the technical feasibility and safety of the technique, including perioperative surgical complications rate and mid-term functional outcomes. Results: Overall, 36 patients undergoing robotic LDNs were included in the study. Of these, 28 (78%) were left LDNs. Median (IQR) donor pre-operative eGFR was 88 (75.6–90) ml/min/1.73 m2. In all cases, robotic LDN was completed without need of conversion. The median (IQR) overall operative time was 230 (195–258) min, while the median console time was 133 (IQR 117-166) min. The median (IQR) warm ischemia time was 175 (140–255) s. No intraoperative adverse events or 90-d major surgical complications were recorded. At a median (IQR) follow-up of 24 months (IQR 11-46), median (IQR) eGFR patients undergoing in living donor nephrectomy was 57.4 (47.9; 63.9) ml/min/1.73 m2. Conclusions: In our experience, robotic LDN is technically feasible and safe. The use of robotic surgery for LDN may provide distinct advantages for surgeons while ensuring optimal donors' perioperative and functional outcomes.
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Affiliation(s)
- Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Luca Gemma
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Isabella Greco
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Paolo Barzaghi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Antonio Andrea Grosso
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Corti
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Nicola Mormile
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Pietro Spatafora
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Caroassai
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Alessandro Berni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Mauro Gacci
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Saverio Giancane
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Agostino Tuccio
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Arcangelo Sebastianelli
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.,Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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Alshuaibi M, Perrenot C, Hubert J, Perez M. Concurrent, face, content, and construct validity of the RobotiX Mentor simulator for robotic basic skills. Int J Med Robot 2020; 16:e2100. [PMID: 32112491 DOI: 10.1002/rcs.2100] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 02/21/2020] [Accepted: 02/23/2020] [Indexed: 01/02/2023]
Abstract
OBJECTIVES To assess several criteria, such as concurrent, face, content, and construct validity of the RobotiX Mentor (RXM) simulator for basic robotic skills and to compare virtual and actual dry lab dome. METHODS A prospective study was conducted from December 2017 to May 2018 using RXM and a da Vinci Si robot. 37 subjects, divided into three groups according to their initial surgical training (expert, intermediate, and novice), were evaluated in terms of six representative exercises of basic robotic specific skills as recommended by the fundamentals of robotic surgery. RESULTS There was a correlation between the automatic data from the RXM and the subjective evaluation with the robot. The face and content validity, which were evaluated by the experts, were generally considered high (71.5% and 62.5%, respectively). Three levels (analysis of variance [ANOVA]; P = .01) and two levels (P = .001) of experience were clearly identified by the simulator. CONCLUSION Our study proves the concurrent validity and confirms the face, content, and construct validity of the RXM.
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Affiliation(s)
- Muaath Alshuaibi
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,Department of Urology, Hospital University, Ha'il, Saudi Arabia
| | - Cyril Perrenot
- School of Surgery, Faculty of Medicine, Lorraine University, Vandœuvre-lès-Nancy, France.,Department of Visceral, Metabolic and Cancerology Surgery, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France
| | - Jacques Hubert
- Department of Urology, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,School of Surgery, Faculty of Medicine, Lorraine University, Vandœuvre-lès-Nancy, France.,IADI Laboratory, INSERM-U1254, Nancy University, Vandœuvre-lès-Nancy, France
| | - Manuela Perez
- Department of Visceral, Metabolic and Cancerology Surgery, Brabois Hospital, University Hospital of Nancy, Vandœuvre-lès-Nancy, France.,IADI Laboratory, INSERM-U947, Nancy University, Vandœuvre-lès-Nancy, France
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9
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Brunotte M, Rademacher S, Weber J, Sucher E, Lederer A, Hau HM, Stolzenburg JU, Seehofer D, Sucher R. Robotic assisted nephrectomy for living kidney donation (RANLD) with use of multiple locking clips or ligatures for renal vascular closure. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:305. [PMID: 32355749 PMCID: PMC7186662 DOI: 10.21037/atm.2020.02.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Robotic assisted nephrectomy for living donation (RANLD) is a rapid emerging surgical technique competing for supremacy with totally laparoscopic and laparoscopic hand assisted techniques. Opinions about the safety of specific techniques of vascular closure in minimally invasive living kidney donation are heterogeneous and may be different for laparoscopic and robotic assisted surgical techniques. Methods We retrospectively analyzed perioperative and short-term outcomes of our first (n=40) RANLD performed with the da Vinci Si surgical platform. Vascular closure of renal vessels was performed by either double clipping or a combination of clips and non-transfixing suture ligatures. Results RANLD almost quintupled in our center for the observed time period. A total of n=21 (52.5%) left and n=19 (47.5%) right kidneys were procured. Renal vessel sealing with two locking clips was performed in 18 cases (45%) Both, clips and non-transfixing ligatures were used in 22 cases (55%). Mean donor age was 53.075±11.68 years (range, 28–70). The average total operative time was 150.75±27.30 min. Right donor nephrectomy (139±22 min) was performed significantly faster than left (160.95±27.93 min, P=0.01). Warm ischemia time was similar for both vascular sealing techniques and did not differ between left and right nephrectomies. No conversion was necessary. Clavien-Dindo Grade ≤IIIb complications occurred in (n=5) 12.5%. Grade IV and V complications did not develop. In particular no hemorrhage occurred using multiple locking clips or suture ligatures for renal vascular closure. Mortality was 0%. Thirteen kidneys (32.5%) were transplanted across the AB0 barrier. Conclusions RANLD is an emerging minimally invasive surgical technique which facilitates excellent perioperative and short-term outcomes also when using multiple locking clips or suture ligatures for renal vascular closure.
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Affiliation(s)
- Maximilian Brunotte
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Justine Weber
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology, Division of Hepatology, University Hospital of Leipzig, Leipzig, Germany
| | - Andri Lederer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
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10
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Néphrectomie laparoscopique assistée par robot dans le cadre du donneur-vivant : étude chez les donneurs et les receveurs à partir de 155 cas. Prog Urol 2019; 29:596-602. [DOI: 10.1016/j.purol.2019.08.263] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2017] [Revised: 05/30/2019] [Accepted: 08/06/2019] [Indexed: 12/23/2022]
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11
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Akin EB, Aydogdu I, Barlas IS. Introducing Robot-Assisted Laparoscopic Donor Nephrectomy after Experience in Hand-Assisted Retroperitoneoscopic Approach. Transplant Proc 2019; 51:2221-2224. [PMID: 31405735 DOI: 10.1016/j.transproceed.2019.02.041] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2019] [Accepted: 02/17/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Robot-assisted laparoscopic donor nephrectomy (RALDN) can help to improve donor safety by enabling enhanced precision, flexibility, control, and vision. We are presenting our initial series during the introduction of RALDN by comparing our adopted surgical technique, hand-assisted retroperitoneoscopic donor nephrectomy (HARPDN), performed at the same time interval. METHODS We performed 12 RALDN and 27 HARPDN with Pfannenstiel incision between March 2018 and July 2018. We evaluated the demographics, operation duration, warm/cold ischemia time, estimated blood loss, length of hospital stay, postoperative complications, and donor and recipient serum creatinine levels retrospectively. RESULTS Demographics including sex, mean of age, and body mass index of the 2 groups were similar. Five cases were right sided nephrectomy in the HARPDN group. We performed only left sided donor nephrectomy in the RALDN group. The duration of operation and warm ischemia time was significantly longer in the robot-assisted group (P < .001). Postoperative major complications were not detected in any of the donors. The function of the transplanted kidneys in both groups was good on the fifth day and 1 month postoperatively. CONCLUSION We introduced the robot-assisted approach for donor candidates who are not suitable candidates for HARPDN in our center. The operation time and warm ischemia time was longer in the RALDN group, but it did not have any impact on outcome. The robot-assisted donor nephrectomy technique can be introduced safely in centers experienced in the hand-assisted approach.
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Affiliation(s)
- Emin Baris Akin
- Istanbul Bilim University, School of Medicine, Sisli Florence Nightingale Hospital, Kidney Transplantation Unit, Istanbul, Turkey
| | - Ibrahim Aydogdu
- Bezmialem Vakif University, School of Medicine, Department of Pediatric Surgery, Kidney Transplantation Unit, Istanbul, Turkey.
| | - Ilhami Soykan Barlas
- Istanbul Bilim University, School of Medicine, Sisli Florence Nightingale Hospital, Kidney Transplantation Unit, Istanbul, Turkey
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12
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Siena G, Vignolini G, Mari A, Li Marzi V, Caroassai S, Giancane S, Sessa F, Minervini A, Breda A, Serni S. Full Robot-Assisted Living Donor Nephrectomy and Kidney Transplantation in a Twin Dedicated Operating Room: Initial Experience From a High-Volume Robotic Center. Surg Innov 2019; 26:449-455. [DOI: 10.1177/1553350619835429] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Purpose. To describe our initial experience with a full robot-assisted approach for living donor nephrectomy (RALDN) and kidney transplantation (RAKT) in a dedicated twin operating room. Methods. From January to December 2017, 5 cases of RALDN and RAKT were performed in a single high-volume robotic center. All patients underwent a standard left RALDN. The renal hilum was controlled with Hem-O-Lok clips (WECK) and the kidney extracted through a Pfannenstiel incision. RAKT was performed according to the Vattikuti Urology Institute–Medanta technique. Results. RALDN: median estimated blood loss was 182 mL (range = 80-450 mL), no postoperative blood transfusion was required. The median (range) warm ischemia time was 175 (90-220 seconds). No conversion was registered. Median console time was 143 minutes (range = 115-220 minutes). No major surgical intraoperative and postoperative early and late complications occurred. RAKT: all 5 patients successfully underwent RAKT. Median (range) console time was 230 (190-200) minutes, vascular suture time was 58.7 (48-73) minutes, cold ischemia time was 46.2 (30-88) minutes, and rewarming time was 61.2 (55-72) minutes. No conversion was required. No major surgical intraoperative and postoperative early and late complications occurred. Mean glomerular filtration rate at days 1, 3, and 7 postoperatively was 26, 42, and 57 (range = 6-90) mL/min/1.73 m2, respectively. No case of delayed graft function was observed. No anastomosis revision, urological complications, lymphocele, and surgical site infection occurred. Conclusions. In our experience, RALDN and RAKT are safe and effective. The intuitiveness of the robotic approach provided substantial benefits both for the living donor and recipient from the very beginning of our series. No intraoperative and postoperative complications occurred.
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Affiliation(s)
- Giampaolo Siena
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Graziano Vignolini
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Mari
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Vincenzo Li Marzi
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Simone Caroassai
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Saverio Giancane
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesco Sessa
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Minervini
- Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy
| | - Alberto Breda
- Department of Urology, Fundaciòn Puigvert, University Autonoma of Barcelona, Barcelona, Spain
| | - Sergio Serni
- Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy
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Donor and Recipient Outcomes following Robotic-Assisted Laparoscopic Living Donor Nephrectomy: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2019; 2019:1729138. [PMID: 31143770 PMCID: PMC6501265 DOI: 10.1155/2019/1729138] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 04/14/2019] [Indexed: 01/30/2023]
Abstract
Aims We aimed to summarize available lines of evidence about intraoperative and postoperative donor outcomes following robotic-assisted laparoscopic donor nephrectomy (RALDN) as well as outcomes of graft and recipients. Methods A systematic review of PubMed/Medline, ISI Web of Knowledge, and Scopus databases was performed in May 2018. The following search terms were combined: nephrectomy, robotic, and living donor. We included full papers that met the following criteria: original research; English language; human studies; enrolling patients undergoing RALDN. Results Eighteen studies involving 910 patients were included in the final analysis. Mean overall operative and warm ischemia times ranged from 139 to 306 minutes and from 1.5 to 5.8 minutes, respectively. Mean estimated blood loss varied from 30 to 146 mL and the incidence of intraoperative complications ranged from 0% to 6.7%. Conversion rate varied from 0% to 5%. The mean hospital length of stay varied from 1 to 5.8 days and incidence of early postoperative complications varied from 0% to 15.7%. No donor mortality was observed. The incidence of delayed graft function was reported in 7 cases. The one- and 10-year graft loss rates were 1% and 22%, respectively. Conclusions Based on preliminary data, RALDN appears as a safe and effective procedure.
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14
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Levi Sandri GB, de Werra E, Mascianà G, Guerra F, Spoletini G, Lai Q. The use of robotic surgery in abdominal organ transplantation: A literature review. Clin Transplant 2016; 31. [PMID: 27726195 DOI: 10.1111/ctr.12856] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/05/2016] [Indexed: 12/13/2022]
Affiliation(s)
- Giovanni B. Levi Sandri
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
- Department of Surgical Sciences; Sapienza University of Rome; Rome Italy
| | - Edoardo de Werra
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Gianluca Mascianà
- Division of General Surgery and Liver Transplantation; San Camillo Hospital; Rome Italy
| | - Francesco Guerra
- Division of Oncological and Robotic General Surgery; Careggi University Hospital; Florence Italy
| | - Gabriele Spoletini
- Department of HPB and Liver Transplant Surgery; Royal Free Hospital; London UK
| | - Quirino Lai
- Transplant Unit; Department of Surgery; University of L'Aquila; San Salvatore Hospital; L'Aquila Italy
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Timsit MO, Kleinclauss F, Mamzer Bruneel M, Thuret R. Le donneur vivant de rein. Prog Urol 2016; 26:940-963. [DOI: 10.1016/j.purol.2016.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023]
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Janki S, Terkivatan T, Kimenai HJAN, IJzermans JNM, Tran TCK. First case report of chylous ascites after robot-assisted donor nephrectomy. J Surg Case Rep 2016; 2016:rjw118. [PMID: 27381018 PMCID: PMC5000837 DOI: 10.1093/jscr/rjw118] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
We present the first case report of chylous ascites following total robot-assisted donor nephrectomy. A 39-year-old female underwent a transperitoneal left-sided total robot-assisted donor nephrectomy. The procedure was uneventful and the patient was discharged without any symptoms. At postoperative Day 29, the patient presented with abdominal pain, nausea and a distended, painful abdomen with shifting dullness. She was diagnosed with chylous ascites by ultrasonography and puncture analysis, and treated with therapeutic drainage and dietary restriction. After 4 weeks, she was free of symptoms. The occurrence of this complication is rare after donor nephrectomy. Fortunately, the complication can be successfully treated within a few weeks with minimal discomfort for the patient as demonstrated in this case. It is of utmost importance to minimize the risks and limit discomfort for live kidney donors who willingly undergo major surgery to improve the well-being of another individual.
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Affiliation(s)
- Shiromani Janki
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Türkan Terkivatan
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Hendrikus J A N Kimenai
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - T C Khé Tran
- Division of HPB and Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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17
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18
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Hiess M, Seitz C. Robot-assisted renal surgery: current status and future directions. ROBOTIC SURGERY : RESEARCH AND REVIEWS 2016; 3:1-12. [PMID: 30697551 PMCID: PMC6193442 DOI: 10.2147/rsrr.s71328] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
This paper examines the current role of robot-assisted renal surgery as complex and partial nephrectomies, including vena cava thrombus, combined nephroureterectomies, living donor nephrectomy, autotransplantation, and difficult anatomy as in patients with obesity or adhesions. Indications for robot-assisted renal surgery are comparable to those of conventional laparoscopic approaches. A reduction in the learning curve leads to a stabilization of the procedure and further increases the number of minimally invasive procedures performed. A Medline literature search for publications on the field of robotic kidney surgery has been performed using the MeSH terms: robotic surgical procedures and kidney. Future directions include progress in robotic technology and instrumentation with further miniaturization of robotic procedures as laparoendoscopic single-site interventions and progress in image-guided robotic surgery.
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Affiliation(s)
- Manuela Hiess
- Department of Urology, Medical University of Vienna, Vienna, Austria,
| | - Christian Seitz
- Department of Urology, Medical University of Vienna, Vienna, Austria,
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19
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Janki S, Klop KWJ, Hagen SM, Terkivatan T, Betjes MGH, Tran TCK, Ijzermans JNM. Robotic surgery rapidly and successfully implemented in a high volume laparoscopic center on living kidney donation. Int J Med Robot 2016; 13. [PMID: 26987773 DOI: 10.1002/rcs.1743] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/13/2016] [Accepted: 02/08/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is important to minimize risks associated with live donor nephrectomy. In this study we evaluated the results of left-sided robot-assisted donor nephrectomies in comparison with standard techniques. METHODS Data on perioperative results, kidney function, and recipient and graft survival were collected. All left-sided laparoscopic and hand-assisted procedures were selected as control groups. RESULTS Fifty-nine robot-assisted procedures were performed by two surgeons. Operative time was significantly longer in the robot-assisted group compared with both control groups. However, it decreased significantly during procedures 40-59 compared with procedures 20-39 (P = 0.014) to median 172.5 (114.0-242.0) min. One conversion to the open approach occurred in the robot group due to a bleeding of the renal artery stump. No difference was found between all techniques at 3 months post-donation. CONCLUSION Left-sided robot-assisted donor nephrectomy is feasible with over time a significant decrease in operative time with good outcomes for donor and recipient. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- S Janki
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K W J Klop
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S M Hagen
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T Terkivatan
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T C K Tran
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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20
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Bhattu AS, Ganpule A, Sabnis RB, Murali V, Mishra S, Desai M. Robot-Assisted Laparoscopic Donor Nephrectomy vs Standard Laparoscopic Donor Nephrectomy: A Prospective Randomized Comparative Study. J Endourol 2015; 29:1334-40. [DOI: 10.1089/end.2015.0213] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Affiliation(s)
- Amit Satish Bhattu
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Arvind Ganpule
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Ravindra B. Sabnis
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Vinodh Murali
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Shashikant Mishra
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
| | - Mahesh Desai
- Department of Urology, Muljibhai Patel Urological Hospital, Nadiad, India
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21
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Robotic nephrectomy for living donation: surgical technique and literature systematic review. Am J Surg 2015; 211:1135-42. [PMID: 26499052 DOI: 10.1016/j.amjsurg.2015.08.019] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2014] [Revised: 07/29/2015] [Accepted: 08/14/2015] [Indexed: 12/22/2022]
Abstract
BACKGROUND As compared with traditional laparoscopy, robotic-assisted surgery provides better EndoWrist instruments and three-dimensional visualization of the operative field. Studies published so far indicate that living donor nephrectomy using the robot-assisted technique is safe, feasible, and provides remarkable advantages for the patients. METHODS From 5 papers reporting detailed descriptions of surgical technique for robotic assisted nephrectomy (RAN) in living donor kidney transplantation, we have gathered information about the surgical techniques as well as about patients' intra- and postoperative outcome. Data from these articles were analyzed together with the data from our own experience (33 cases) so that the total number of analyzed cases was 292. RESULTS In the analyzed populations, no case of donor death occurred, and no case developed complication above grade 2 of Clavien score. Perioperative complications occurred in 37 of the 292 patients (12.6%). Accidental acute hemorrhage occurred in 5 of the 292 cases (1.7%). The average overall intraoperative blood loss was 67.8 mL (range 10 to 1,500). The average warm ischemia time was 3.5 minutes (range .58 to 7.6). Conversion to the open technique occurred in only 4 cases (1.3%). The average overall operative time was 192 minutes (range 60 to 400). The average length of the hospital stay was 2.7 days (range 1 to 10). CONCLUSIONS Safety and feasibility of RAN are pointed out in all the reviewed article, both as hand-assisted and as totally robotic technique. RAN appears to be significantly easier for the surgeons and the results are comparable with the ones obtained with the pure laparoscopic technique.
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22
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Szold A, Bergamaschi R, Broeders I, Dankelman J, Forgione A, Langø T, Melzer A, Mintz Y, Morales-Conde S, Rhodes M, Satava R, Tang CN, Vilallonga R. European Association of Endoscopic Surgeons (EAES) consensus statement on the use of robotics in general surgery. Surg Endosc 2014; 29:253-88. [PMID: 25380708 DOI: 10.1007/s00464-014-3916-9] [Citation(s) in RCA: 98] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2014] [Accepted: 09/19/2014] [Indexed: 12/14/2022]
Abstract
Following an extensive literature search and a consensus conference with subject matter experts the following conclusions can be drawn: 1. Robotic surgery is still at its infancy, and there is a great potential in sophisticated electromechanical systems to perform complex surgical tasks when these systems evolve. 2. To date, in the vast majority of clinical settings, there is little or no advantage in using robotic systems in general surgery in terms of clinical outcome. Dedicated parameters should be addressed, and high quality research should focus on quality of care instead of routine parameters, where a clear advantage is not to be expected. 3. Preliminary data demonstrates that robotic system have a clinical benefit in performing complex procedures in confined spaces, especially in those that are located in unfavorable anatomical locations. 4. There is a severe lack of high quality data on robotic surgery, and there is a great need for rigorously controlled, unbiased clinical trials. These trials should be urged to address the cost-effectiveness issues as well. 5. Specific areas of research should include complex hepatobiliary surgery, surgery for gastric and esophageal cancer, revisional surgery in bariatric and upper GI surgery, surgery for large adrenal masses, and rectal surgery. All these fields show some potential for a true benefit of using current robotic systems. 6. Robotic surgery requires a specific set of skills, and needs to be trained using a dedicated, structured training program that addresses the specific knowledge, safety issues and skills essential to perform this type of surgery safely and with good outcomes. It is the responsibility of the corresponding professional organizations, not the industry, to define the training and credentialing of robotic basic skills and specific procedures. 7. Due to the special economic environment in which robotic surgery is currently employed special care should be taken in the decision making process when deciding on the purchase, use and training of robotic systems in general surgery. 8. Professional organizations in the sub-specialties of general surgery should review these statements and issue detailed, specialty-specific guidelines on the use of specific robotic surgery procedures in addition to outlining the advanced robotic surgery training required to safely perform such procedures.
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Affiliation(s)
- Amir Szold
- Technology Committee, EAES, Assia Medical Group, P.O. Box 58048, Tel Aviv, 61580, Israel,
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Giacomoni A, Di Sandro S, Lauterio A, Mangoni I, Mihaylov P, Concone G, Tripepi M, Poli C, Cusumano C, De Carlis L. Initial experience with robot-assisted nephrectomy for living-donor kidney transplantation: feasibility and technical notes. Transplant Proc 2014; 45:2627-31. [PMID: 24034009 DOI: 10.1016/j.transproceed.2013.07.038] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
BACKGROUND Robot-assisted surgery provide endowrist instruments and 3-dimensional visualization of the operative field that are improvements over traditional laparoscopy. The few research studies published so far have demonstrated that living-donor nephrectomy using the robot-assisted technique is safe and feasible, providing advantages for patients. METHODS Since November 2009, we performed 20 robot-assisted living-donor nephrectomies. Eight patients underwent hand-assisted robotic nephrectomy, whereas 20, totally robotic nephrectomy. RESULTS Median intraoperative bleeding was 174 mL (range, 10-750) but no patient needed intraoperative transfusion with blood cells. The median warm ischemia time was 3.16 minutes (range, 0.30-6.5). there was no case of conversion to an open procedure. The median operative time was 311 minutes (range, 85-530); the median console time was 160 minutes (range, 135-220). CONCLUSION Robot-assisted living-donor kidney recovery was a safe and effective procedure. The totally robotic recovery is an evolving technique. The prospect of robotic staplers, endowrist ligature, and robotic single port may further increase these advantages.
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Affiliation(s)
- A Giacomoni
- Department of General Surgery and Transplantation, Niguarda Ca' Granda Hospital, Milan, Italy.
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24
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Monn MF, Gramm AR, Bahler CD, Yang DY, Sundaram CP. Economic and Utilization Analysis of Robot-Assisted Versus Laparoscopic Live Donor Nephrectomy. J Endourol 2014; 28:780-3. [DOI: 10.1089/end.2014.0014] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Affiliation(s)
- M. Francesca Monn
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Alec R. Gramm
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Clinton D. Bahler
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - David Y. Yang
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
| | - Chandru P. Sundaram
- Department of Urology, Indiana University School of Medicine, Indianapolis, Indiana
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Abstract
PURPOSE We describe a technique of complete intracorporeal renal autotransplantation with donor nephrectomy and transplantation performed in a minimally invasive fashion without extracting the kidney. MATERIALS AND METHODS We developed this technique of a completely intracorporeal robotic renal autotransplantation and determined the feasibility of this novel procedure. This includes a method of intracorporeal transarterial hypothermic renal perfusion using a perfusion catheter through a laparoscopic port. The procedure was successfully applied in a 56-year-old man with extensive left ureteral loss after failed ureteroscopy for ureterolithiasis. RESULTS Robotic donor nephrectomy was performed with a warm ischemia time of 2.3 minutes. Subsequently cold ischemia was achieved by intracorporeal hypothermic renal perfusion for 95.5 minutes. Vascular anastomoses and ureteroureterostomy in the ipsilateral pelvis were completed after donor nephrectomy with a total overall surgeon console time of 334 minutes. Venous and arterial anastomosis times were 17.3 and 21.3 minutes, respectively. Estimated blood loss was less than 50 ml. There were no complications and the patient was discharged home on postoperative day 1 after normal Doppler transplant renal ultrasound. Postoperative renal scan at 6 weeks, intravenous urogram at 8 weeks and computerized tomography urography at 5 months revealed normal function and successful ureteral reconstruction. CONCLUSIONS We report the feasibility of a technique of a completely intracorporeal robotic renal autotransplantation. This operation may be considered in select patients in the hands of experienced robotic surgeons. However, further refinement is required as this novel procedure is cautiously reproduced and adopted by others.
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Laplace B, Ladrière M, Claudon M, Eschwege P, Kessler M, Hubert J. Néphrectomie chez le donneur vivant par voie laparoscopique robot-assistée : évaluation préopératoire et résultats à partir de 100 cas. Prog Urol 2014; 24:288-93. [DOI: 10.1016/j.purol.2013.09.024] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2013] [Revised: 09/19/2013] [Accepted: 09/20/2013] [Indexed: 10/26/2022]
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Giacomoni A, Di Sandro S, Lauterio A, Concone G, Mangoni I, Mihaylov P, Tripepi M, De Carlis L. Evolution of robotic nephrectomy for living donation: from hand-assisted to totally robotic technique. Int J Med Robot 2014; 10:286-93. [PMID: 24599640 DOI: 10.1002/rcs.1576] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2013] [Revised: 11/27/2013] [Accepted: 01/02/2014] [Indexed: 11/10/2022]
Affiliation(s)
- Alessandro Giacomoni
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Stefano Di Sandro
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
- Department of Surgical Sciences; University of Pavia; Italy
| | - Andrea Lauterio
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Giacomo Concone
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
- Department of Surgical Sciences; University of Pavia; Italy
| | - Iacopo Mangoni
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Plamen Mihaylov
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Matteo Tripepi
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation; Niguarda Ca' Granda Hospital; Milan Italy
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Abstract
PURPOSE OF REVIEW To analyze the current status of robotic-assisted pancreas transplantation as a treatment option for diabetic patients. RECENT FINDINGS Pancreas transplant recipients continue to suffer high rates of technical complications, including wound infections, fascial dehiscence, and postoperative ventral hernias. Robotic technology can potentially contribute to decreasing these dangerous complications and improve the postoperative course of pancreas transplantation. SUMMARY Current literature on both robotic pancreas and robotic kidney transplant were reviewed in order to determine feasibility, safety, and efficacy of robotic pancreas transplantation. To date, only three cases of robotic pancreas transplantation, two of which were solely pancreas transplantation and one combined pancreas-kidney transplantation, have been reported in a single publication by an Italian group. Their preliminary data show that robotic pancreas transplantation is feasible and well tolerated. The authors believe that robotic pancreas transplantation could have a prominent role in lone pancreas transplantation performed in overweight recipients, in parallel to their experience with fully robotic kidney transplant in morbidly obese candidates. Broader experience with this innovative approach will be necessary to establish if robotic pancreas transplantation will be a beneficial option for diabetic patients needing beta-cell replacement.
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Liu XS, Narins HW, Maley WR, Frank AM, Lallas CD. Robotic-assistance does not enhance standard laparoscopic technique for right-sided donor nephrectomy. JSLS 2013; 16:202-7. [PMID: 23477166 PMCID: PMC3481222 DOI: 10.4293/108680812x13427982376068] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Robotic-assistance did not improve outcomes associated with laparoscopic donor nephrectomy in this study. Objective: To examine donor and recipient outcomes after right-sided robotic-assisted laparoscopic donor nephrectomy (RALDN) compared with standard laparoscopic donor nephrectomy (LDN) and to determine whether robotic-assistance enhances LDN. Materials & Methods: From December 2005 to January 2011, 25 patients underwent right-sided LDN or RALDN. An IRB-approved retrospective review was performed of both donor and recipient medical charts. Primary endpoints included both intraoperative and postoperative outcomes. Results: Twenty right-sided LDNs and 5 RALDNs were performed during the study period. Neither estimated blood loss (76.4mL vs. 30mL, P=.07) nor operative time (231 min vs. 218 min, P=.61) were significantly different between either group (LDN vs. RALDN). Warm ischemia time for LDN was 2.6 min vs. 3.8 min for RALDN (P=.44). Donor postoperative serum estimated glomerular filtration rates (eGFR) were similar (53 vs. 59.6mL/min/1.73m2, LDN vs. RALDN, P=.26). For the recipient patients, posttransplant eGFR were similar at 6 months (53.4 vs. 59.8mL/min/1.73m2, LDN vs. RALDN, P=.53). Conclusion: In this study, robotic-assistance did not improve outcomes associated with LDN. Larger prospective studies are needed to confirm any perceived benefit of RALDN.
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Affiliation(s)
- Xiaolong S Liu
- Department of Urology, Thomas Jefferson University, Philadelphia, PA, USA
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30
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[Surgical aspects of living donor nephrectomy]. Actas Urol Esp 2013; 37:181-7. [PMID: 22840385 DOI: 10.1016/j.acuro.2012.05.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Accepted: 05/11/2012] [Indexed: 11/21/2022]
Abstract
CONTEXT Living donor renal transplant surgery has evolved from the classical nephrectomy by lumbotomy to less invasive surgery, the laparoscopic and robotic nephrectomy currently being the most important. It is important to know the available evidence on whether nephrectomy in patients with multiple arteries, right kidney and in obese patients can be performed safely when there is a correct indication. OBJECTIVE To perform a review of the different surgical techniques in living donor nephrectomy, adapted to the current surgical evidence and other aspects related to the indication. EVIDENCE ACQUISITION A systematic review was made in PubMed (1997-2011). This included previous reviews randomized controlled clinical studies, cohort studies, and meta-analyses of this surgical aspects of living donor nephrectomy. CONCLUSIONS Currently, there is sufficient evidence to consider living donor laparoscopic nephrectomy as the technique of choice, although the role of hand-assisted retroperitoneoscopic technique is still not totally clear. Open surgery techniques using mini-incision are an acceptable alternative for the sites that have not yet implemented laparoscopic surgery. Right kidney nephrectomy, of those cases that present multiple pedicles and in obese donors, is justified in selected cases.
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Transvaginal Hybrid Natural Orifice Transluminal Surgery Robotic Donor Nephrectomy: First Clinical Application. Urology 2012. [DOI: 10.1016/j.urology.2012.08.061] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Musculoskeletal disorders among spine surgeons: results of a survey of the Scoliosis Research Society membership. Spine (Phila Pa 1976) 2011; 36:E1715-21. [PMID: 21508887 DOI: 10.1097/brs.0b013e31821cd140] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Survey of surgeon members of the Scoliosis Research Society. OBJECTIVE To assess the prevalence of musculoskeletal disorders (MSDs) among spine surgeons. SUMMARY OF BACKGROUND DATA Spinal deformity surgery is characterized by long duration and repetitive, forceful tasks. The purpose of this study is to describe the type and prevalence of MSDs among orthopedic spine surgeons. METHODS A modified version of the physical discomfort survey was sent to surgeon members of the Scoliosis Research Society via standard mail and e-mail. A total of 3 attempts to contact potential respondents were made, with 62% (561/904 × 100) responding. Mean respondent age was 54 years. Mean annual total caseload was 147, of which 62 were of spinal deformity. A total of 84% of the respondents had an active surgical practice. RESULTS The most common self-reported diagnoses included neck pain/strain/spasm (38%, 215/561), lumbar disc herniation/radiculopathy (31%, 172/561), cervical disc herniation/radiculopathy (28%, 155/561), rotator cuff disease (24%, 134/561), varicose veins or peripheral edema (20%, 112/561), and lateral epicondylitis (18%, 99/561). For lumbar disc disease, 7.1% (40/561 × 100) and for cervical disc disease, 4.6% (26/561 × 100) of spine surgeons underwent surgery. Among active spine surgeons, multiple linear regression analysis revealed that total caseload correlated with neck pain (P = 0.01) and lower extremity edema (P = 0.03), while the number of deformity cases correlated with wrist pain (P = 0.003) and hand pain (P = 0.03). Age was correlated with shoulder (P = 0.03), elbow (P = 0.04), and hand pain (P = 0.02). Number of years in practice did not correlate with MSDs. CONCLUSION Compared with disease estimates in the general population, spine surgeons have a higher prevalence of MSDs. Our cohort underwent surgical intervention for lumbar (7.1%) and cervical (4.6%) disc disease at rates far exceeding disease estimates in the general population. Increased awareness among spine surgeons may lead to earlier treatment and, ultimately, enhanced preventive measures.
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Barlow AD, Nicholson ML. Recent advances in laparoscopic live donor nephrectomy. Br J Surg 2011; 98:1501-2. [PMID: 21918957 DOI: 10.1002/bjs.7686] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- A D Barlow
- Department of Transplant Surgery, University Hospitals of Leicester, Gwendolen Road, Leicester LE5 4PW, UK.
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Robotic-assisted laparoscopic donor nephrectomies: early experience and review of the literature. J Robot Surg 2011; 5:115-20. [DOI: 10.1007/s11701-011-0245-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2010] [Accepted: 01/03/2011] [Indexed: 12/16/2022]
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Dols LFC, Kok NFM, IJzermans JNM. Live donor nephrectomy: a review of evidence for surgical techniques. Transpl Int 2010; 23:121-30. [DOI: 10.1111/j.1432-2277.2009.01027.x] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
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Louis G, Hubert J, Ladriere M, Frimat L, Kessler M. Transplantation rénale à partir de donneurs vivants prélevés sous laparoscopie assistée par robot. À propos d’une série de 35 cas. Nephrol Ther 2009; 5:623-30. [DOI: 10.1016/j.nephro.2009.06.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2009] [Revised: 06/21/2009] [Accepted: 06/22/2009] [Indexed: 01/10/2023]
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