Vignolini Graziano, Greco Isabella, Sessa Francesco, Gemma Luca, Pecoraro Alessio, Barzaghi Paolo, Grosso Antonio, Corti Francesco, Mormile Nicola, Martiriggiano Marco, Berni Alessandro, Firenzuoli Niccolò, Gacci Mauro, Giancane Saverio, Sebastianelli Arcangelo, Li Marzi Vincenzo, Serni Sergio, Campi Riccardo
Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Florence, Italy.
Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy.
Front Surg. 2020 Nov 11;7:583798. doi: 10.3389/fsurg.2020.583798. eCollection 2020.
To report the University of Florence technique for robot-assisted kidney transplantation (RAKT) from living donor (LD) and deceased donor (DD), highlighting the evolution of surgical indications and technical nuances in light of a single surgeon's learning curve. A dedicated program for RAKT from LDs was developed at our Institution in 2017 and implemented later with a specific framework for DDs. All RAKTs were performed by a single highly experienced surgeon. Data from patients undergoing RAKT between January 2017 and December 2019 were prospectively collected in a dedicated web-based data platform. In this report we provide a comprehensive step-by-step overview of our technique for RAKT, focusing on the potential differences in peri-operative and mid-term functional outcomes between LDs vs. DDs. Overall, 160 KTs were performed in our center during the study period. Of these, 39 (24%) were performed with a robot-assisted laparoscopic technique, both from LDs ( = 18/39 [46%]) and from DDs ( = 21/39 [54%]). Eleven (11/39 [18%]), 13(13/39 [26%]), and 15 (15/39 [30%]) RAKTs were performed in 2017, 2018, and 2019, respectively, highlighting an increasing adoption of robotics for KT over time at our Institution. Median time for arterial (19 min for LD and 18 min for DD groups), venous (21 min for LD, 20 min for DD) and uretero-vesical (18 min for LD and 15 for DD) anastomosis were comparable between the two groups (all > 0.05), as the median rewarming time (59 min vs. 56 min, = 0.4). The rate of postoperative surgical complications according to Clavien-Dindo classification did not differ between the two study groups, except for Clavien-Dindo grade II complications (higher among patients undergoing RAKT from DDs, 76 vs. 44%, = 0.042). Overall, 7/39 (18%) patients (all recipients from DDs) experienced DGF; two of them were on dialysis at last FU. Our experience confirms the feasibility, safety, and favorable mid-term outcomes of RAKT from both LDs and DDs in appropriately selected recipients, highlighting the opportunity to tailor the technique to specific recipient- and/or graft-characteristics. Further research is needed to refine the technique for RAKT and to evaluate the benefits and harms of robotics for kidney transplantation from DDs.
报告佛罗伦萨大学开展的活体供体（LD）和 deceased donor（DD）机器人辅助肾移植（RAKT）技术，根据单一外科医生的学习曲线，重点介绍手术适应症的演变和技术细节。2017年我们机构制定了一项针对LD的RAKT专项计划，随后实施了针对DD的特定框架。所有RAKT手术均由一位经验丰富的外科医生完成。2017年1月至2019年12月期间接受RAKT的患者数据前瞻性收集于一个专门的基于网络的数据平台。在本报告中，我们全面逐步概述了我们的RAKT技术，重点关注LD与DD在围手术期和中期功能结局方面的潜在差异。在研究期间，我们中心共进行了160例肾移植手术。其中，39例（24%）采用机器人辅助腹腔镜技术，包括来自LD的（18/39 [46%]）和来自DD的（21/39 [54%]）。2017年、2018年和2019年分别进行了11例（11/39 [18%]）、13例（13/39 [26%]）和15例（15/39 [30%]）RAKT手术，表明随着时间推移我们机构越来越多地采用机器人技术进行肾移植。两组之间动脉吻合（LD组19分钟，DD组18分钟）、静脉吻合（LD组21分钟，DD组20分钟）和输尿管膀胱吻合（LD组18分钟，DD组15分钟）的中位时间相当（均P>0.05），中位复温时间也相当（59分钟对56分钟，P = 0.4）。根据Clavien-Dindo分类法，术后手术并发症发生率在两个研究组之间没有差异，除了Clavien-Dindo II级并发症（DD来源的RAKT患者中更高，76%对44%，P = 0.042）。总体而言，39例患者中有7例（18%）（均为DD来源的受者）发生移植肾功能延迟恢复（DGF）；其中2例在最后一次随访时仍在透析。我们的经验证实了在适当选择的受者中，LD和DD来源的RAKT具有可行性、安全性和良好的中期结局，突出了根据特定受者和/或移植物特征调整技术的机会。需要进一步研究来完善RAKT技术，并评估机器人技术用于DD肾移植的利弊。
