Robot-Assisted versus Conventional Open Kidney Transplantation: A Meta-Analysis

Abstract

Background. Perioperative and follow-up outcomes for patients that received robot-assisted kidney transplant (RAKT), compared to patients that received conventional open kidney transplant (OKT), remain unknown. We performed a meta-analysis of controlled studies to compare the safety and efficacy of RAKT versus OKT. Methods. Systematic searching of PubMed, Embase, and Cochrane Library databases was performed to identify relevant randomized or nonrandomized controlled studies. Perioperative, in-hospital, and follow-up outcomes were summarized. A random-effect model incorporating the potential heterogeneity was used to synthesize the results. Results. Six nonrandomized controlled studies including 263 patients with RAKT and 804 patients with OKT were included. Pooled results showed that compared to those that received OKT, patients that received RAKT had significant higher rewarming time (mean difference (MD): 20.8 min, p < 0.001 ) and total ischemia time (MD: 17.8 min, p = 0.008 ) but a lower incidence of surgical site infection (SSI, risk ratio (RR): 0.22, p = 0.03 ). The incidence of delayed graft function was comparable between groups (RR: 1.10, p = 0.82 ), and the length of hospital stay was similar (MD: -2.03 days, p = 0.21 ). During a follow-up of 31 months, patients that received RAKT and OKT had similar serum creatinine levels (MD: 10.12 mmol/L, p = 0.42 ) and similar incidences of graft rejection (RR: 1.16, p = 0.53 ), graft failure (RR: 0.94, p = 0.79 ), and all-cause mortality (RR: 1.16, p = 0.77 ). Conclusion. Current evidence from nonrandomized studies suggests that RAKT is associated with a lower risk of SSI and similar midterm functional and clinical efficacy compared to OKT. Randomized studies are needed to validate these findings.

Comparable kidney transplant outcomes in selected patients with a body mass index ≥ 40: A personalized medicine approach to recipient selection

“…There is other encouraging evidence for pre‐transplant bariatric surgery, and attention to pre‐transplant weight loss continues to be warranted in order to add more deserving patients to the waitlist and improve the likelihood of excellent technical outcomes following kidney transplantation 35 . Finally, robotic kidney transplantation has gained traction as an opportunity to perform technically feasible and safe transplants in morbidly obese recipients at selected centers 36–38 . This modality can allow for successful transplantation in some obese individuals who do not meet imaging‐based criteria for transplant eligibility such as those outlined in this study and are unable to achieve meaningful weight loss prior to transplant.…”

“…35 Finally, robotic kidney transplantation has gained traction as an opportunity to perform technically feasible and safe transplants in morbidly obese recipients at selected centers. [36][37][38] This modality can allow for successful transplantation in some obese individuals who do not meet imaging-based criteria for transplant eligibility such as those outlined in this study and are unable to achieve meaningful weight loss prior to transplant. In sum, different modalities should be considered according to an individual patient's characteristics and weight loss is appropriate to encourage in almost all obese kidney transplant candidates.…”

Anesthetic Challenges and Perioperative Factors Affecting Delayed Graft Function in Robotic-Assisted Kidney Transplant: A Review of a Single-Center Experience of 100 Cases

“…Liu et al, in their meta-analysis of six nonrandomized studies, found that although the RAKT group had significantly higher rewarming time and total ischemia time, the incidence of DGF was comparable with open transplants [ 14 ]. Although the safe upper limit of WIT is not known, prolonged WIT has been associated with increased DGF.…”

Metaverse in Medical Education

“…35 The advancement of robot-assisted kidney transplantation has shown several benefits over conventional open kidney transplant procedures; however, identifying atheromatous plaques can be challenging, with surgeons unable to manually palpate potential plaque in the iliac vessels. 36 A virtual 3D model is obtained from a computed tomography scan imaging and then superimposed in real-time on the actual iliac vessels of the patients. van Leeuwen and van der Hage 37 showed several concepts that the metaverse could help to advance minimally invasive and robotic surgery, including: (1) high-fidelity procedural planning based on preoperative 3D imaging roadmaps, (2) the superimposition of live data and 3D imagery on endoscopic views (e.g., mixed reality visualizations and GPS-like navigation strategies), (3) dynamic lesion/ tissue characterization via intraoperative imaging (e.g., drop-in ultrasound for in-depth detection) or fluorescence imaging (superficial detection), and ( 4) the use of machine learning strategies to alleviate the mounting cognitive input, to advance the interpretation of the surgical data output, and to guide image-topatient registration.…”