Giampaolo Siena1, Riccardo Campi2, Karel Decaestecker3, Volkan Tuğcu4, Selcuk Sahin4, Antonio Alcaraz5, Mireia Musquera5, Angelo Territo6, Luis Gausa6, Caren Randon7, Michael Stockle8, Martin Janssen8, Paolo Fornara9, Nasreldin Mohammed9, Luis Guirado10, Carme Facundo10, Nicolas Doumerc11, Graziano Vignolini12, Alberto Breda6, Sergio Serni12. 1. Department of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: giampaolo.siena@gmail.com. 2. Department of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy. Electronic address: riccardo.campi@gmail.com. 3. Department of Urology, Ghent University Hospital, Ghent, Belgium. 4. Department of Urology, Bakirkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. 5. Department of Urology, Hospital Clinic, Barcelona, Spain. 6. Department of Urology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain. 7. Department of Thoracic and Vascular Surgery, Ghent University Hospital, Ghent, Belgium. 8. Department of Urology, University Saarland, Homburg/Saar, Germany. 9. Department of Urology, University Hospital Halle (Saale), Halle, Germany. 10. Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain. 11. Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France. 12. Department of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy.
Abstract
BACKGROUND: Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. OBJECTIVE: To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTS: We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. INTERVENTION: RAKT with regional hypothermia. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. RESULTS AND LIMITATIONS: Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88min, p=0.004 and 50 vs 34min, p=0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra- or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. CONCLUSIONS: RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. PATIENT SUMMARY: In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications.
BACKGROUND: Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. OBJECTIVE: To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. DESIGN, SETTING, AND PARTICIPANTS: We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. INTERVENTION: RAKT with regional hypothermia. OUTCOME MEASUREMENTS AND STATISTICAL ANALYSIS: Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. RESULTS AND LIMITATIONS: Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88min, p=0.004 and 50 vs 34min, p=0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra- or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. CONCLUSIONS: RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. PATIENT SUMMARY: In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications.
Authors: Vital Hevia; Victoria Gómez; Manuel Hevia; Javier Lorca; Marta Santiago; Jose López-Plaza; Sara Álvarez; Víctor Díez; Cristina Gordaliza; Francisco Javier Burgos Journal: Curr Urol Rep Date: 2020-01-31 Impact factor: 3.092
Authors: Thomas Prudhomme; Jean Baptiste Beauval; Marine Lesourd; Mathieu Roumiguié; Karel Decaestecker; Graziano Vignolini; Riccardo Campi; Sergio Serni; Angelo Territo; Luis Gausa; Volkan Tugcu; Selcuk Sahin; Antonio Alcaraz; Mireia Musquera; Michael Stockle; Martin Janssen; Paolo Fornara; Nasreldin Mohammed; Arnaud Del Bello; Nassim Kamar; Federico Sallusto; Alberto Breda; Nicolas Doumerc Journal: World J Urol Date: 2020-06-19 Impact factor: 4.226
Authors: Ellen L K Dobrijevic; Eric H K Au; Natasha M Rogers; Philip A Clayton; Germaine Wong; Richard D M Allen Journal: Transpl Int Date: 2022-04-04 Impact factor: 3.842