Background

Robot-assisted kidney transplantation (RAKT) has recently been introduced to reduce the morbidity of open kidney transplantation (KT).

Objective

To evaluate perioperative and early postoperative RAKT outcomes.

Design, setting and participants

This was a multicenter prospective observational study of 120 patients who underwent RAKT, predominantly with a living donor kidney, in eight European institutions between July 2015 and May 2017, with minimum follow-up of 1 mo. The robot-assisted surgical steps were transperitoneal dissection of the external iliac vessels, venous/arterial anastomosis, graft retroperitonealization, and ureterovesical anastomosis.

Outcome measurements and statistical analysis

Descriptive analysis of surgical data and their correlations with functional outcomes.

Results and limitations

The median operative and vascular suture time was 250 and 38 min, respectively. The median estimated blood loss was 150 ml. No major intraoperative complications occurred, although two patients needed open conversion. The median postoperative estimated glomerular filtration rate was 21.2, 45.0, 52.6, and 58.0 ml/min on postoperative day 1, 3, 7, and 30, respectively. Both early and late graft function were not related to overall operating time or rewarming time. Five cases of delayed graft function (4.2%) were reported. One case (0.8%) of wound infection, three cases (2.5%) of ileus, and four cases of bleeding (3.3%; three of which required blood transfusion), managed conservatively, were observed. One case (0.8%) of deep venous thrombosis, one case (0.8%) of lymphocele, and three cases (2.5%) of transplantectomy due to massive arterial thrombosis were recorded. In five cases (4.2%), surgical exploration was performed for intraperitoneal hematoma. Limitations of the study include selection bias, the lack of an open control group, and failure to report on patient cosmetic satisfaction.

Conclusions

When performed by surgeons with robotic and KT experience, RAKT is safe and reproducible in selected cases and yields excellent graft function.

Patient summary

We present the largest reported series on robot-assisted kidney transplantation. Use of a robotic technique can yield low complication rates, rapid recovery, and excellent graft function. Further investigations need to confirm our promising data.

中文翻译：

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机器人辅助肾脏移植：欧洲​​经验

背景

最近已经引入了机器人辅助肾脏移植（RAKT），以减少开放性肾脏移植（KT）的发病率。

客观的

评估围手术期和术后早期RAKT结局。

设计，设置和参与者

这是一项多中心前瞻性观察性研究，研究对象为2015年7月至2017年5月间在欧洲的8家机构中接受RAKT且主要是活体供体肾脏的120例患者。机器人辅助的手术步骤是trans外血管经腹膜解剖，静脉/动脉吻合，移植物腹膜后化和输尿管膀胱吻合。

成果测量和统计分析

对手术数据及其与功能结局的相关性进行描述性分析。

结果与局限性

手术和血管缝合的中位时间分别为250和38分钟。中位数估计失血量为150毫升。尽管有两名患者需要进行开放式手术，但没有发生重大的术中并发症。术后第1、3、7和30天，估计的中位肾小球滤过率中位数分别为21.2、45.0、52.6和58.0 ml / min。早期和晚期移植物功能均与总体手术时间或复温时间无关。据报道有五例移植物功能延迟（4.2％）。观察到保守治疗的1例（0.8％）伤口感染，3例（2.5％）肠梗阻和4例出血（3.3％；其中3例需要输血）。深静脉血栓形成1例（0.8％），淋巴结肿大1例（0.8％），3例（2。记录了由于大动脉血栓形成而导致的5％的移植手术。在5例（4.2％）的情况下，对腹膜内血肿进行了手术探查。该研究的局限性包括选择偏见，缺乏开放的对照组和未能报告患者的美容满意度。

结论

当由具有机器人和KT经验的外科医生进行手术时，RAKT在某些情况下是安全且可重现的，并具有出色的移植功能。

病人总结

我们介绍了有关机器人辅助肾脏移植的最大报道系列。使用机器人技术可以降低并发症发生率，恢复快并具有出色的移植功能。进一步的调查需要确认我们有希望的数据。