Division of Transplantation, Department of Surgery, University of Illinois at Chicago, Chicago, IL.
College of Medicine, University of Illinois at Chicago, Chicago, IL.
Am J Transplant. 2021 Apr;21(4):1525-1534. doi: 10.1111/ajt.16322. Epub 2020 Oct 15.
Patients with obesity have limited access to kidney transplantation, mainly due to an increased incidence of surgical complications, which could be reduced with selective use of robotic-assisted surgery. This prospective randomized controlled trial compares the safety and efficacy of combining robotic sleeve gastrectomy and robotic-assisted kidney transplant to robotic kidney transplant alone in candidates with class II or III obesity. Twenty candidates were recruited, 11 were randomized to the robotic sleeve gastrectomy and robotic-assisted kidney transplant group and 9 to the robotic kidney transplant group. At 12-month follow-up, change in body mass index was -8.76 ± 1.82 in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group compared to 1.70 ± 2.30 in the robotic kidney transplant group (P = .0041). Estimated glomerular filtration rate, serum creatinine, readmission rates, and graft failure rates up to 12 months were not different between the two groups. Length of surgery was longer in the robotic sleeve gastrectomy and robotic-assisted kidney transplant group (405 minutes vs. 269 minutes, p = .00304) without increase in estimated blood loss (120 ml vs. 117 ml, p = .908) or incidence of surgical complications. Combined robotic-assisted kidney transplant and sleeve gastrectomy is safe and effective compared to robotic-assisted kidney transplant alone.
肥胖患者接受肾移植的机会有限，主要是由于手术并发症的发生率增加，如果选择性地使用机器人辅助手术，则可以降低这种风险。本前瞻性随机对照试验比较了在 II 类或 III 类肥胖患者中联合使用机器人袖状胃切除术和机器人辅助肾移植与单独使用机器人肾移植的安全性和疗效。共招募了 20 名候选者，其中 11 名随机分为机器人袖状胃切除术和机器人辅助肾移植组，9 名随机分为机器人肾移植组。在 12 个月的随访中，与机器人肾移植组相比，机器人袖状胃切除术和机器人辅助肾移植组的体重指数变化为 -8.76 ± 1.82（P = 0.0041）。两组在肾小球滤过率估计值、血清肌酐、再入院率和 12 个月内的移植物失效率方面没有差异。机器人袖状胃切除术和机器人辅助肾移植组的手术时间较长（405 分钟 vs. 269 分钟，p = 0.00304），但估计失血量（120 毫升 vs. 117 毫升，p = 0.908）或手术并发症发生率没有增加。与单独使用机器人辅助肾移植相比，联合使用机器人辅助肾移植和袖状胃切除术是安全有效的。
