Grammens Julien, Schechter Michal Yaela, Desender Liesbeth, Claeys Tom, Sinatti Céline, VandeWalle Johan, Vermassen Frank, Raes Ann, Vanpeteghem Caroline, Prytula Agnieszka, Silay Mesrur Selçuk, Breda Alberto, Decaestecker Karel, Spinoit Anne-Françoise
Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium.
Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium.
Front Surg. 2021 Mar 25;8:649418. doi: 10.3389/fsurg.2021.649418. eCollection 2021.
Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical-material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.
肾移植被公认为终末期肾病（ESKD，或根据最新命名法为慢性肾脏病5期）患者的金标准治疗方法。机器人辅助肾移植（RAKT）在成人中逐渐成为首选技术，即使仅在极少数中心应用，与开放肾移植相比，其临床结局可能有所改善。迄今为止，仅有极少数儿童RAKT手术的相关描述。肾移植受者因免疫功能低下，围手术期手术并发症的风险可能增加，这给管理带来了额外挑战。应用微创手术技术可能有助于改善小儿移植患者群体的临床结局，并有助于减轻肾移植的发病率。然而，仍有许多挑战摆在面前。与同等的开放手术相比，微创手术一直被证明能产生更好的临床结局。机器人辅助腹腔镜手术（RALS）能够克服传统腹腔镜手术的许多限制，尤其是在复杂且要求高的手术过程中。尽管有这些改进，但除了麻醉和经济方面的考虑外，手术和技术材料领域仍面临许多挑战。由于小儿腹腔小和循环血容量减少等特殊特征，儿童RALS对手术团队和麻醉团队都提出了额外挑战。文中讨论了成本效益、美观和功能伤口结局、接受RALS的最小年龄和体重以及RAKT对移植物功能的影响。尽管儿童RAKT的数据很少，但它是一种安全可行的手术，能带来出色的移植物功能。该手术应由在RALS和移植手术方面都有经验的RAKT团队进行，并得到小儿肾脏病学和麻醉学团队的全力支持。有必要进行进一步研究，以更好地确定机器人手术方法与腹腔镜手术和开放手术方法相比的价值。成本效益仍将是一个重要的辩论主题，也需要进一步评估。
