Li Marzi Vincenzo, Pecoraro Alessio, Gallo Maria Lucia, Caroti Leonardo, Peris Adriano, Vignolini Graziano, Serni Sergio, Campi Riccardo
Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy.
Nephrology Unit, Careggi Hospital, Florence 50134, Italy.
World J Transplant. 2022 Jul 18;12(7):163-174. doi: 10.5500/wjt.v12.i7.163.
Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint, KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery, especially due to its potential benefits for fragile and immunocompromised recipients. It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea, Development, Exploration, Assessment, Long-term follow-up recommendations for introducing surgical innovations into real-life practice. During the last years, mirroring the Vattikuti-Medanta technique, several centers developed RAKT program worldwide, providing strong evidence about the safety and the feasibility of this procedure. However, the majority of RAKT are still performed in the living donor setting, as an "eligible" procedure, while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation. In addition, despite the spread of minimally-invasive (predominantly robotic) surgery worldwide, many KTs are still performed in an open fashion. Regardless of the type of incision employed by surgeons, open KT may lead to non-negligible risks of wound complications, especially among obese patients. Particularly, the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications. In this context, robotic surgery could offer several benefits, including providing a better exposure of the surgical field and better instrument maneuverability, as well as the possibility to integrate other technological nuances, such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.
肾移植（KT）是终末期肾病患者的首选治疗方法，与透析相比，其生存率和生活质量更高。尽管在KT患者的医疗管理方面取得了进展，但从纯粹的外科角度来看，在过去50年里KT一直抗拒创新。最近，机器人辅助肾移植（RAKT）已被提议作为开放手术的替代方法，特别是因为它对脆弱和免疫功能低下的受者可能有益。直到2014年，由于开创性的Vattikuti泌尿外科研究所 - 梅丹塔合作，RAKT的作用才得以体现，该合作按照将外科创新引入实际临床实践的理念、开发、探索、评估、长期随访建议，构思并开发了一种新的RAKT手术技术。在过去几年里，全球多个中心效仿Vattikuti - 梅丹塔技术开展了RAKT项目，为该手术的安全性和可行性提供了有力证据。然而，大多数RAKT手术仍在活体供肾的情况下进行，作为一种“合格”的手术方式，而只有少数中心在尸体供肾这一具有挑战性的情况下通过机器人手术完成了肾移植。此外，尽管微创（主要是机器人辅助）手术在全球范围内广泛传播，但许多肾移植手术仍以开放方式进行。无论外科医生采用何种切口类型，开放肾移植都可能导致不可忽视的伤口并发症风险，尤其是在肥胖患者中。特别是，肾移植评估不仅应考虑额外的手术技术挑战，还应考虑术后并发症的更高风险。在这种背景下，机器人手术可以带来诸多益处，包括更好地暴露手术视野、更好的器械可操作性，以及整合其他技术细节的可能性，例如在输尿管膀胱吻合术前使用吲哚菁绿进行术中荧光血管成像以评估输尿管血管化。因此，我们的综述旨在报告关于RAKT的更重要经验，重点关注结果和未来展望。
