Prospective Non-Randomized Open Label Trial Comparing Outcome of Open Versus Robotic Pediatric Kidney Transplant at Single Centre

Patel, Dhruv; Singla, S. K.; Mishra, Amit; Chauhan, Rohit; Patel, Himanshu; Kute, Vivek; Saha, Arindam; Vala, Kinnari; Modi, Pranjal

doi:10.1097/01.tp.0000698360.42101.4d

Cited by 2 publications

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“…In the OKT group (n = 20), two patients had slow graft function, two lost graft, and two deceased during follow-up. There was no significant observed difference in graft survival or overall survival (23). Both Modi et al and Patel et al (22,23) concluded that RAKT is feasible and safe, however, a more thorough and comprehensive analysis of the specifics of their experiences could help increase the external validity of their findings.…”

Section: Current Evidencementioning

confidence: 93%

“…One child experienced spontaneous graft rupture on the 3rd postoperative day requiring emergency exploration ( 22 ). A prospective non-randomized open label trial by Patel et al ( 23 ) compared outcomes of open vs. robot-assisted pediatric KT at a single center, involving 60 and 22 patients undergoing RAKT and OKT, respectively. Endpoints of their trial were feasibility of RAKT and creatinine value at 30 days post-transplantation.…”

Section: Current Evidencementioning

confidence: 99%

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Pediatric Challenges in Robot-Assisted Kidney Transplantation

et al. 2021

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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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Section: Current Evidencementioning

confidence: 93%

Section: Current Evidencementioning

confidence: 99%