Robot-assisted Kidney Transplantation: The European Experience

Breda, Alberto; Territo, Angelo; Gausa, L.; Tuğcu, Volkan; Alcaraz, Antonio; Musquera, Mireía; Decaestecker, Karel; Desender, Liesbeth; Stöckle, Michael; Janssen, Martin; Fornara, Paolo; Mohammed, Nasreldin; Siena, Giampaolo; Serni, Sergio; Guirado, Luís; Facundo, Carmen; Doumerc, N.

doi:10.1016/j.eururo.2017.08.028

Cited by 108 publications

(112 citation statements)

References 24 publications

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“…In our previous multicentre series of 120 RAKTs, we reported five cases of delayed graft function and three of arterial thrombosis early in the learning curve. These complications were not deemed to be related to the longer rewarming time in robotic surgery; graft exposure to the intra‐abdominal temperature and the pneumoperitoneum pressure does not affect early graft function up to the end of the first postoperative month . Similar results were reported at up to 6 months of follow‐up in a different study .…”

Section: Discussionsupporting

confidence: 72%

“…In a recently published systematic review, no significant differences were observed between the different approaches used (open, laparoscopic and robotic) in terms of patient and graft survival . In a series of 120 RAKTs from living donors reported by Breda et al (the ERUS RAKT working group), in which functional outcomes were evaluated with a minimum postoperative follow‐up of 1 month, three cases of graft loss (2.5%) requiring transplantectomy occurred as a result of massive arterial thrombosis. These cases of arterial thrombosis occurred at the beginning of the RAKT programme and were attributable to technical mistakes during the learning curve .…”

Section: Discussionmentioning

confidence: 98%

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European experience of robot‐assisted kidney transplantation: minimum of 1‐year follow‐up

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Section: Discussionsupporting

confidence: 72%

Section: Discussionmentioning

confidence: 98%

European experience of robot‐assisted kidney transplantation: minimum of 1‐year follow‐up

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“…RAKT was performed using either the Si (first five cases) or Xi (from case 6 to case 17) da Vinci robotic platform in a four‐arm configuration, similar to robot‐assisted radical prostatectomy, using a 0 ° lens, as previously described .…”

Section: Methodsmentioning

confidence: 99%

“…Prospective non‐randomised trials following the Innovation, Development, Exploration, Assessment and Long‐term Study (IDEAL) framework have shown the technical feasibility and safety of robot‐assisted kidney transplantation (RAKT) with regional hypothermia from living donors . These results were confirmed by further large prospective multicentre studies within the European Association of Urology (EAU) Robotic Urology Section (ERUS)‐RAKT Working Group . Overall, available evidence outlines that RAKT achieves similar patient and graft survival as compared to open KT, adding the advantages of minimally invasive surgery .…”

Section: Introductionmentioning

confidence: 94%

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Development of a robot‐assisted kidney transplantation programme from deceased donors in a referral academic centre: technical nuances and preliminary results

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Objective To report the development of the first robot‐assisted kidney transplantation (RAKT) programme from deceased donors, examining technical feasibility and early perioperative and functional outcomes at a referral academic centre. Patients and Methods A RAKT programme was developed in 2016 at our institution following structured modular training. Specific inclusion/exclusion criteria for both living and deceased donors were set. Data from patients undergoing RAKT from January 2017 to April 2018 were prospectively collected in an a priori developed web‐based data set. RAKT followed the principles of the Vattikuti Urology Institute–Medanta technique, with specific technical modifications based on clinical recipient characteristics, as well as surgeon's skills and preference during the learning curve. Technical feasibility of RAKT from deceased donors and evaluation of perioperative and early functional outcomes were the main study endpoints. Results In all, 17 RAKTs were performed during the study period. Of these, six were from living donors and 11 were from deceased donors. All RAKTs were successfully completed without need of conversion. The median (interquartile range [IQR]) console time was 190 (160–220) min and the median (IQR) estimated blood loss was 120 (110–140) mL. The median times to complete venous, arterial and uretero–vesical anastomoses were 21, 22 and 21 min, respectively. The median (IQR) length of stay was 8 (6–12) days. At a median (IQR) follow‐up of 8 (6–11) months, five (30%) complications were recorded. Of these, four (24%) were minor (Clavien–Dindo Grade I–II) and one major (Clavien–Dindo Grade IIIb, requiring graft nephrectomy). Overall, two patients were still on dialysis at last follow‐up. A significant improvement in graft function was recorded progressively at all postoperative time points. Conclusion Our preliminary experience outlines that: (i) the development of a RAKT programme is feasible in centres experienced in robotic surgery and open kidney transplantation; (ii) RAKT from deceased donors is feasible from both a technical and logistical perspective; and (iii) RAKT from deceased donors appears to achieve favourable early postoperative and functional outcomes. Larger studies with longer follow‐up are needed to confirm these findings and compare the outcomes of RAKT from deceased donors with those from living donors.

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