Robotic kidney transplantation allows safe access for transplant renal biopsy and percutaneous procedures

Campi, Riccardo; Vignolini, Graziano; Savi, Elena; Sessa, Francesco; Agostini, S.; Serni, Sergio

doi:10.1111/tri.13517

Cited by 9 publications

(6 citation statements)

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“…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%

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

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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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

et al. 2020

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“…Interestingly, we recorded a laminar perirenal fluid collection in almost all patients at ultrasound examinations during the first postoperative period (i.e., postoperative days 1 and 7 and at hospital discharge). However, subsequent follow-up evaluations showed a progressive reduction of this fluid collection until complete reabsorption within 20-30 days after surgery, confirming the complete retroperitonealization of the graft [37].…”

Section: Overview Of the Main Steps For Arterial Anastomosis During Rmentioning

confidence: 60%

“…Then, the graft is allocated in the extraperitoneal pouch, which is partially closed by reapproximating the previously prepared peritoneal flaps with a V-lock running suture or single Hem-o-lok clips. This step avoids graft torsion, facilitates postoperative graft monitoring, and allows convenient access for ultrasound-guided transplant renal biopsy and/or placement of nephrostomy tubes, if needed [37]. Interestingly, we recorded a laminar perirenal fluid collection in almost all patients at ultrasound examinations during the first postoperative period (i.e., postoperative days 1 and 7 and at hospital discharge).…”

Section: Overview Of the Main Steps For Arterial Anastomosis During Rmentioning

confidence: 82%

Robot-Assisted Kidney Transplantation

Decaestecker¹,

Territo²,

Campi³

et al. 2020

Medical Robotics - New Achievements

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Robot-assisted kidney transplantation (RAKT) has recently been introduced to reduce the morbidity of open kidney transplantation (KT). Robot-assisted surgery has been able to overcome many of the limitations of classical laparoscopy, certainly in complex and technically demanding procedures, such as vascular and ureteral anastomosis. Since the first RAKT in 2010, this technique has been standardized and evaluated in highly experienced robot and KT centers around the world. In Europe, the European Association of Urology Robotic Urology Section (ERUS) created an RAKT working group in 2016 in order to prospectively follow the outcomes of RAKT. When performed by surgeons with both robotic and KT experience, RAKT has been proven to be safe and reproducible in selected cases and yield excellent graft function with a low complication rate. Multiple institutions have now adopted RAKT, and its use will likely increase in the near future. However, structured training and proctoring will be mandatory for those embarking on RAKT in order to help them negotiate the learning curve and avoid technical mistakes. This chapter will describe RAKT from living and deceased donors and its application in kidney autotransplantation (KAT).

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“…The peritoneum is closed with hem-o-loks so that its permeability decreases the risk of lymphocele in the postoperative course. Moreover, the extra-peritonealization of the graft resembles the open technique and allows easy access to the kidney for percutaneous biopsy or nephrostomy tube placement [13]. or prospective series (Table 1) [14-17, 18••].…”

Section: Surgical Techniquementioning

confidence: 99%

Living Donor Robot-Assisted Kidney Transplantation: a New Standard of Care?

et al. 2021

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Purpose of Review Robot-assisted kidney transplantation (RAKT) has the potential to combine the advantages of minimally invasive surgery with the best renal replacement treatment. Over the last decade, the results were encouraging, as surgical and functional outcomes seem optimal in living donation. Recent studies focused on the comparison with open kidney transplantation (OKT), special situations such as obese patients or multiple vessels grafts and optimization of the technique to increase its surgical indications. Recent Findings Relative to OKT, RAKT has longer rewarming time and operative time, but lower intraoperative blood loss. Wound-related events and postoperative pain decrease with robotic technique. This has been also demonstrated in obese patients, where RAKT may be particularly beneficial. No significant difference was found in graft function, graft survival, and patient survival with RAKT and OKT in short-and mid-term follow-up. A multiple vessels graft should not be considered a contraindication to robotic surgery. Intracorporeal cooling systems for regional hypothermia have not been applied in RAKT yet. Future challenges will be the inclusion of patients with atheromatous iliac arteries and transplantation programs for deceased donors. Summary A randomized-controlled trial is needed to definitively confirm the findings of retrospective and prospective cohort studies. The implementation of the procedure in more centers depends on broader indications, which might ultimately decrease procedure-related costs. To guarantee the applicability of RAKT from deceased donors, it is fundamental to optimize the graft cooling systems and to include recipients with atheromatous iliac arteries.

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Robotic kidney transplantation allows safe access for transplant renal biopsy and percutaneous procedures

Cited by 9 publications

References 9 publications

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

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

Robot-Assisted Kidney Transplantation

Living Donor Robot-Assisted Kidney Transplantation: a New Standard of Care?

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