Siena Giampaolo, Vignolini Graziano, Mari Andrea, Li Marzi Vincenzo, Caroassai Simone, Giancane Saverio, Sessa Francesco, Minervini Andrea, Breda Alberto, Serni Sergio
1 Unit of Oncologic Minimally-Invasive Urology and Andrology, Department of Urology, Careggi Hospital, University of Florence, Florence, Italy.
2 Department of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
Surg Innov. 2019 Aug;26(4):449-455. doi: 10.1177/1553350619835429. Epub 2019 Apr 25.
. To describe our initial experience with a full robot-assisted approach for living donor nephrectomy (RALDN) and kidney transplantation (RAKT) in a dedicated twin operating room. . From January to December 2017, 5 cases of RALDN and RAKT were performed in a single high-volume robotic center. All patients underwent a standard left RALDN. The renal hilum was controlled with Hem-O-Lok clips (WECK) and the kidney extracted through a Pfannenstiel incision. RAKT was performed according to the Vattikuti Urology Institute-Medanta technique. RALDN: median estimated blood loss was 182 mL (range = 80-450 mL), no postoperative blood transfusion was required. The median (range) warm ischemia time was 175 (90-220 seconds). No conversion was registered. Median console time was 143 minutes (range = 115-220 minutes). No major surgical intraoperative and postoperative early and late complications occurred. RAKT: all 5 patients successfully underwent RAKT. Median (range) console time was 230 (190-200) minutes, vascular suture time was 58.7 (48-73) minutes, cold ischemia time was 46.2 (30-88) minutes, and rewarming time was 61.2 (55-72) minutes. No conversion was required. No major surgical intraoperative and postoperative early and late complications occurred. Mean glomerular filtration rate at days 1, 3, and 7 postoperatively was 26, 42, and 57 (range = 6-90) mL/min/1.73 m, respectively. No case of delayed graft function was observed. No anastomosis revision, urological complications, lymphocele, and surgical site infection occurred. . In our experience, RALDN and RAKT are safe and effective. The intuitiveness of the robotic approach provided substantial benefits both for the living donor and recipient from the very beginning of our series. No intraoperative and postoperative complications occurred.
描述我们在专用双手术室中采用全机器人辅助方法进行活体供肾肾切除术（RALDN）和肾移植术（RAKT）的初步经验。2017年1月至12月，在一个高容量机器人中心进行了5例RALDN和RAKT手术。所有患者均接受标准的左侧RALDN。肾蒂用Hem - O - Lok夹（WECK）控制，肾脏通过耻骨上横切口取出。RAKT按照瓦蒂库蒂泌尿学研究所 - 梅丹塔技术进行。RALDN：估计失血量中位数为182 mL（范围 = 80 - 450 mL），无需术后输血。热缺血时间中位数（范围）为175（90 - 220秒）。无中转记录。控制台时间中位数为143分钟（范围 = 115 - 220分钟）。术中及术后早期和晚期均未发生重大手术并发症。RAKT：所有5例患者均成功接受RAKT。控制台时间中位数（范围）为230（190 - 270）分钟，血管缝合时间为58.7（48 - 73）分钟，冷缺血时间为46.2（30 - 88）分钟，复温时间为61.2（55 - 72）分钟。无需中转。术中及术后早期和晚期均未发生重大手术并发症。术后第1天、第3天和第7天的平均肾小球滤过率分别为26、42和57（范围 = 6 - 90）mL/min/1.73 m²。未观察到移植肾功能延迟的病例。未发生吻合口修复、泌尿系统并发症、淋巴囊肿和手术部位感染。根据我们的经验，RALDN和RAKT是安全有效的。从我们系列研究开始，机器人手术方法的直观性就为活体供体和受体带来了实质性益处。术中及术后均未发生并发症。
