Breda Alberto, Diana Pietro, Territo Angelo, Gallioli Andrea, Piana Alberto, Gaya Josep Maria, Gavrilov Pavel, Desender Liesbeth, Van Parys Benjamin, Van Praet Charles, Lambert Edward, Khene Zine-Eddine, Dang Vanti, Doumerc Nicolas, Decaestecker Karel
Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain.
Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain; Department of Urology, Humanitas Clinical and Research Institute IRCCS, Rozzano, Italy.
Eur Urol. 2022 Feb;81(2):168-175. doi: 10.1016/j.eururo.2021.07.023. Epub 2021 Aug 12.
Kidney autotransplantation is a useful technique to be reserved for cases in which kidney function is compromised by a complex anatomical configuration, such as long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction. Robot-assisted kidney autotransplantation (RAKAT) presents a novel, minimally invasive, and highly accurate approach.
The aim of this study is to present the largest cohort of patients who underwent either extracorporeal (eRAKAT) or intracorporeal (iRAKAT) RAKAT, to confirm safety and feasibility and to compare the two approaches.
DESIGN, SETTING, AND PARTICIPANTS: We retrospectively analyzed prospectively followed patients undergoing eRAKAT and totally intracorporeal RAKAT in a total of three institutions.
Extracorporeal RAKAT and iRAKAT.
Surgical and functional outcomes of patients subjected to eRAKAT and iRAKAT were measured.
Between January 2017 and February 2021, 29 patients underwent RAKAT: 15 eRAKAT and 14 iRAKAT. No statistical difference in the preoperative data was recorded. The analysis of intraoperative variables showed a statistically significant difference between eRAKAT and iRAKAT in cold ischemia time (median [interquartile range {IQR}]: 151 [125-199] vs 27.5 [20-55]; p < 0.001) and total ischemia time (median [IQR]: 196.2 [182-241] vs 81.5 [73-88]; p < 0.001). However, faster renal function recovery in favor of eRAKAT was observed during the first 90 d, with comparable renal function at 1 yr. The 90-d Clavien-Dindo >2 complications were 13.8%. It is important to stress that RAKAT, and above all iRAKAT, should be performed by surgeons with experience in robotic renal, vascular, and transplant surgery.
Both eRAKAT and iRAKAT represent promising minimally invasive techniques in selected cases with acceptable ischemia time and comparable long-term operative outcomes.
In selected patients, both extra- and intracorporeal robot-assisted kidney autotransplantation represent valid alternatives in case of long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction.
肾自体移植是一种有用的技术，适用于因复杂解剖结构导致肾功能受损的病例，如长段输尿管狭窄和不适合原位重建的肾血管异常。机器人辅助肾自体移植（RAKAT）是一种新颖、微创且高度精确的方法。
本研究旨在呈现接受体外（eRAKAT）或体内（iRAKAT）RAKAT的最大患者队列，以确认安全性和可行性，并比较这两种方法。
设计、设置和参与者：我们回顾性分析了在三个机构中接受eRAKAT和完全体内RAKAT的前瞻性随访患者。
体外RAKAT和体内RAKAT。
对接受eRAKAT和iRAKAT的患者的手术和功能结果进行测量。
2017年1月至2021年2月期间，29例患者接受了RAKAT：15例eRAKAT和14例iRAKAT。术前数据无统计学差异。术中变量分析显示，eRAKAT和iRAKAT在冷缺血时间（中位数[四分位间距{IQR}]：151[125 - 199] vs 27.5[20 - 55]；p < 0.001）和总缺血时间（中位数[IQR]：196.2[182 - 241] vs 81.5[73 - 88]；p < 0.001）方面存在统计学显著差异。然而，在最初90天内观察到eRAKAT的肾功能恢复更快，1年时肾功能相当。90天Clavien - Dindo >2级并发症发生率为13.8%。重要的是要强调，RAKAT，尤其是iRAKAT，应由具有机器人肾脏、血管和移植手术经验的外科医生进行。
在缺血时间可接受且长期手术结果相当的特定病例中，eRAKAT和iRAKAT都是有前景的微创技术。
在特定患者中，对于长段输尿管狭窄和不适合原位重建的肾血管异常，体外和体内机器人辅助肾自体移植都是有效的替代方法。
