Andrea Gallioli1,2, Juan Gómez Rivas3,4, Alessandro Larcher5,4, Alberto Breda6. 1. Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Calle Cartagena 340 - 350, 08035, Barcelona, Spain. andrea.gallioli@gmail.com. 2. Young Academic Urologists (YAU), European Association of Urology, Arnhem, The Netherlands. andrea.gallioli@gmail.com. 3. Department of Urology, Clínico San Carlos University Hospital, Madrid, Spain. 4. Young Academic Urologists (YAU), European Association of Urology, Arnhem, The Netherlands. 5. Unit of Urology, Division of Experimental Oncology, Urological Research Institute (URI), IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy. 6. Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Calle Cartagena 340 - 350, 08035, Barcelona, Spain.
Abstract
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. 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.
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. 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.
Authors: J Oberholzer; P Giulianotti; K K Danielson; M Spaggiari; L Bejarano-Pineda; F Bianco; I Tzvetanov; S Ayloo; H Jeon; R Garcia-Roca; J Thielke; I Tang; S Akkina; B Becker; K Kinzer; A Patel; E Benedetti Journal: Am J Transplant Date: 2013-03 Impact factor: 8.086
Authors: P Giulianotti; V Gorodner; F Sbrana; I Tzvetanov; H Jeon; F Bianco; K Kinzer; J Oberholzer; E Benedetti Journal: Am J Transplant Date: 2010-05-10 Impact factor: 8.086
Authors: Ulrich Pein; Matthias Girndt; Silke Markau; Annekathrin Fritz; Alberto Breda; Michael Stöckle; Nasreldin Mohammed; Felix Kawan; Andre Schumann; Paolo Fornara; Karl Weigand Journal: World J Urol Date: 2019-05-24 Impact factor: 4.226
Authors: Volkan Tuğcu; Nevzat Can Şener; Selçuk Şahin; Abdullah H Yavuzsan; Fatih G Akbay; Süheyla Apaydın Journal: BJU Int Date: 2017-10-15 Impact factor: 5.588