Robot‐assisted kidney transplantation: update from the European Robotic Urology Section (ERUS) series

Abstract

Objective To report the results of the robot‐assisted kidney transplantation (RAKT) experience performed in 10 European centres by members of the European Robotic Urology Section (ERUS)‐RAKT group. Patients and Methods This is a multicentre prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intraoperative outcomes, complications rate and functional results were collected and analysed. Results Between July 2015 and September 2019, 291 living‐donor RAKTs were performed. Recipients were mostly male (189 [65%]), the mean Standard deviation (sd) age was 45.2 (13.35) years, the mean (sd) body mass index was 27.13 (19.28) kg/m2, and RAKT was pre‐emptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used in 15.4%. The mean (sd) total surgical and re‐warming time was 244 (70.5) min and 53.16 (15.27) min, respectively. In all, 17 patients presented with postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one due to acute rejection. Two patients had arterial stenosis, three had incisional hernias, six had ureteric stenosis, and nine had lymphoceles. Neither surgical nor re‐warming times were correlated with postoperative serum creatinine levels (P > 0.05). Comparison of surgical data between the first 120 cases and the following 171 cases showed a significantly shorter total surgical time in the second group (265 vs 230 min, P = 0.005). Conclusions This is the largest European multicentre study of RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centres with a wide experience in open kidney transplantation and robotic surgery.

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

“…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).…”

Clinical Outcomes Following Single vs. Multiple Vessel Living-Donor Kidney Transplantation: A Retrospective Comparison of 210 Patients

“…In recent years minimally invasive operative techniques such as robot-assisted kidney transplantation (RAKT) has been successfully introduced in both living and deceased donor transplants ( 27 – 32 ). In one of these studies ( 29 ), a comparison of single ( N = 127) vs. multiple ( N = 21) vessel living-donor RAKT was performed in which the vascular reconstruction techniques performed on the back table were similar to ours reported here.…”

Pediatric Challenges in Robot-Assisted Kidney Transplantation

“…In the years since, RAKT has become an increasingly common procedure in selected high-volume centers. This can be attributed to promising results which have indicated RAKT to be a safe, feasible and reproducible procedure with a potentially improved morbidity as compared to open kidney transplantation (OKT) (16,17).…”

“…Warm ischemia time has already been shown to be a negative predictive factor of long-term patient and graft survival outcomes (35). In the adult RAKT series, a wide range of ischemia times has been described, but no correlation has been found between rewarming time and graft function (16,17). To reduce potential damage after prolonged warm ischemia times, Menon et al have reported a new technique for regional hypothermia with ice slush during vascular anastomosis (15).…”