Prospective Nonrandomized Comparison Between Open and Robot-Assisted Kidney Transplantation: Analysis of Midterm Functional Outcomes

Maheshwari, Ruchir; Qadri, S.Y.; Rakhul, L R; Chaturvedi, Saurabh; Desai, Pragnesh; Grover, Rahul; Chhabra, Gagan Deep; Khullar, Dinesh; Kumar, Anant

doi:10.1089/end.2020.0213

“…Although RAKT is still being performed only at selected referral Centers worldwide, current evidence confirms is feasibility, safety and reproducibility (1,2,19,20). In fact, RAKT with regional hypothermia in the setting of "elective" living donation has been shown to achieve favorable short-and mid-term perioperative and functional outcomes (mirroring the principles of open KT) while providing the key advantages of minimallyinvasive surgery (2,3,6,8,(19)(20)(21)(22)(23). Moreover, recent studies demonstrated that RAKT can be safely performed by experienced robotic surgeons even in case of grafts with vascular anomalies (5) or complex recipients such as those with ADPKD (16) or morbid obesity (7,24,25).…”

Section: Discussionmentioning

confidence: 99%

“…Preoperative donor, recipient and graft characteristics are shown in Table 1 (21)(22)(23)(24)(25) in the LD and DD groups, respectively.…”

Section: Characteristics Of the Study Cohortmentioning

confidence: 99%

The University of Florence Technique for Robot-Assisted Kidney Transplantation: 3-Year Experience

Vignolini

¹

,

Greco

²

,

Sessa

³

et al. 2020

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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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“…The remaining 30 articles underwent full-text review, and 23 articles were further excluded because nine studies were case reports or case series of patients with RAKT without OKT control groups, 12 were studies of robot-assisted laparoscopic donor nephrectomy, and the other two were abstracts already included studies. Finally, seven articles [14][15][16][17][18][19][20] were retrieved. Since two articles described inhospital and long-term outcomes of the same study population separately [14,16], a total of six studies were included.…”

Section: Resultsmentioning

confidence: 99%

“…Overall, six nonrandomized controlled studies, including 263 patients with RAKT and 804 patients with OKT, were included in the meta-analysis (Table 1) [14][15][16][17][18][19][20]. These studies were published after 2013 and performed in the United States [14][15][16], Turkey [17], Germany [20], and India [18,19], respectively. Patients that received RAKT and OKT were generally frequency-matched on age, sex, race, donor compatibility, disease, and dialysis history.…”

Section: Studymentioning

confidence: 99%

“…However, besides better skin cosmesis which is evident in RAKT than OKT, efficacies of RAKT compared to OKT on intraoperative, in-hospital, and follow-up outcomes in recipients of kidney transplantation remain to be determined [12,13]. Although some comparative studies comparing RAKT and OKT have been published [14][15][16][17][18][19][20], these studies were of limited scale and their results were not consistent. Therefore, we performed a meta-analysis of controlled studies to compare the safety and efficacy of RAKT versus OKT.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Robot-Assisted versus Conventional Open Kidney Transplantation: A Meta-Analysis

Liu

¹

,

Deng

²

,

Zhang

³

et al. 2020

BioMed Research International

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Background. Perioperative and follow-up outcomes for patients that received robot-assisted kidney transplant (RAKT), compared to patients that received conventional open kidney transplant (OKT), remain unknown. We performed a meta-analysis of controlled studies to compare the safety and efficacy of RAKT versus OKT. Methods. Systematic searching of PubMed, Embase, and Cochrane Library databases was performed to identify relevant randomized or nonrandomized controlled studies. Perioperative, in-hospital, and follow-up outcomes were summarized. A random-effect model incorporating the potential heterogeneity was used to synthesize the results. Results. Six nonrandomized controlled studies including 263 patients with RAKT and 804 patients with OKT were included. Pooled results showed that compared to those that received OKT, patients that received RAKT had significant higher rewarming time (mean difference (MD): 20.8 min, p < 0.001 ) and total ischemia time (MD: 17.8 min, p = 0.008 ) but a lower incidence of surgical site infection (SSI, risk ratio (RR): 0.22, p = 0.03 ). The incidence of delayed graft function was comparable between groups (RR: 1.10, p = 0.82 ), and the length of hospital stay was similar (MD: -2.03 days, p = 0.21 ). During a follow-up of 31 months, patients that received RAKT and OKT had similar serum creatinine levels (MD: 10.12 mmol/L, p = 0.42 ) and similar incidences of graft rejection (RR: 1.16, p = 0.53 ), graft failure (RR: 0.94, p = 0.79 ), and all-cause mortality (RR: 1.16, p = 0.77 ). Conclusion. Current evidence from nonrandomized studies suggests that RAKT is associated with a lower risk of SSI and similar midterm functional and clinical efficacy compared to OKT. Randomized studies are needed to validate these findings.

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