Background

Kidney autotransplantation is a useful technique to be reserved for cases in which kidney function is compromised by a complex anatomical configuration, such as long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction. Robot-assisted kidney autotransplantation (RAKAT) presents a novel, minimally invasive, and highly accurate approach.

Objective

The aim of this study is to present the largest cohort of patients who underwent either extracorporeal (eRAKAT) or intracorporeal (iRAKAT) RAKAT, to confirm safety and feasibility and to compare the two approaches.

Design, setting, and participants

We retrospectively analyzed prospectively followed patients undergoing eRAKAT and totally intracorporeal RAKAT in a total of three institutions.

Surgical procedure

Extracorporeal RAKAT and iRAKAT.

Measurements

Surgical and functional outcomes of patients subjected to eRAKAT and iRAKAT were measured.

Results and limitations

Between January 2017 and February 2021, 29 patients underwent RAKAT: 15 eRAKAT and 14 iRAKAT. No statistical difference in the preoperative data was recorded. The analysis of intraoperative variables showed a statistically significant difference between eRAKAT and iRAKAT in cold ischemia time (median [interquartile range {IQR}]: 151 [125–199] vs 27.5 [20–55]; p < 0.001) and total ischemia time (median [IQR]: 196.2 [182–241] vs 81.5 [73–88]; p < 0.001). However, faster renal function recovery in favor of eRAKAT was observed during the first 90 d, with comparable renal function at 1 yr. The 90-d Clavien-Dindo >2 complications were 13.8%. It is important to stress that RAKAT, and above all iRAKAT, should be performed by surgeons with experience in robotic renal, vascular, and transplant surgery.

Conclusions

Both eRAKAT and iRAKAT represent promising minimally invasive techniques in selected cases with acceptable ischemia time and comparable long-term operative outcomes.

Patient summary

In selected patients, both extra- and intracorporeal robot-assisted kidney autotransplantation represent valid alternatives in case of long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction.

中文翻译：

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体外与体外机器人辅助肾脏自体移植：ERUS RAKT 工作组的经验

背景

自体肾移植是一种有用的技术，可用于肾功能因复杂解剖结构而受损的情况，例如长输尿管狭窄和不适合原位重建的肾血管异常。机器人辅助肾脏自体移植 (RAKAT) 提供了一种新颖、微创且高度准确的方法。

客观的

本研究的目的是展示接受体外 (eRAKAT) 或体内 (iRAKAT) RAKAT 的最大患者队列，以确认安全性和可行性并比较这两种方法。

设计、设置和参与者

我们回顾性分析了在总共三个机构中接受 eRAKAT 和完全体内 RAKAT 的前瞻性随访患者。

外科手术

体外 RAKAT 和 iRAKAT。

测量

测量了接受 eRAKAT 和 iRAKAT 的患者的手术和功能结果。

结果和局限性

2017 年 1 月至 2021 年 2 月期间，29 名患者接受了 RAKAT：15 名 eRAKAT 和 14 名 iRAKAT。术前数据无统计学差异。术中变量分析显示，eRAKAT 和 iRAKAT 在冷缺血时间（中位数 [四分位距 {IQR}]：151 [125–199] vs 27.5 [20–55]；p  < 0.001）和总缺血时间方面存在统计学显着差异（中位数 [IQR]：196.2 [182–241] vs 81.5 [73–88]；p < 0.001)。然而，在最初的 90 天观察到有利于 eRAKAT 的肾功能恢复更快，在 1 年时肾功能具有可比性。90 天 Clavien-Dindo >2 并发症为 13.8%。需要强调的是，RAKAT，尤其是 iRAKAT，应该由具有机器人肾脏、血管和移植手术经验的外科医生执行。

结论

eRAKAT 和 iRAKAT 都代表了在选定病例中具有可接受的缺血时间和可比的长期手术结果的有前途的微创技术。

患者总结

在选定的患者中，体外和体内机器人辅助肾脏自体移植是输尿管长狭窄和不适合原位重建的肾血管异常的有效替代方案。