Department of Surgery, Washington University School of Medicine, 660 Euclid Ave, St. Louis, MO, 63110, USA.
Surg Endosc. 2023 Oct;37(10):7511-7519. doi: 10.1007/s00464-023-10246-z. Epub 2023 Jul 6.
Robotic donor nephrectomy (RDN) has emerged as a safe alternate to laparoscopic donor nephrectomy (LDN), offering improved visualization, instrument dexterity and ergonomics. There is still concern about how to safely transition from LDN to RDN.
We performed a retrospective review of 150 consecutive living donor operations (75 LDN and 75 RDN) at our center, comparing the first 75 RDN's with the last 75 LDN's performed prior to the initiation of the robotic transplant program. Operative times and complications were used as surrogates of efficiency and safety, respectively, to estimate the learning curve with RDN.
RDN was associated with a longer total operative time (RDN 182 vs LDN 144 min; P < 0.0001) but a significantly shorter post-operative length of stay (RDN 1.8 vs LDN 2.1 days; P = 0.0213). Donor complications and recipient outcomes were the same between both groups. Learning curve of RDN was estimated to be about 30 cases.
RDN is a safe alternate to LDN with acceptable donor morbidity and no negative impact on recipient outcomes even during the early part of the RDN learning curve. Surgeon preferences for the robotic approach compared to traditional laparoscopy will require further scrutiny to improve ergonomics and operative efficiency.
机器人辅助供体肾切除术 (RDN) 已成为腹腔镜供体肾切除术 (LDN) 的安全替代方法，提供了更好的可视化、器械灵巧性和人体工程学。人们仍然担心如何安全地从 LDN 过渡到 RDN。
我们对我们中心的 150 例连续活体供体手术（75 例 LDN 和 75 例 RDN）进行了回顾性分析，将机器人移植项目启动前最后 75 例 LDN 与前 75 例 RDN 进行比较。手术时间和并发症分别作为效率和安全性的替代指标，用于估计 RDN 的学习曲线。
RDN 与更长的总手术时间相关（RDN 182 分钟 vs LDN 144 分钟；P<0.0001），但术后住院时间明显缩短（RDN 1.8 天 vs LDN 2.1 天；P=0.0213）。两组供体并发症和受者结局相同。RDN 的学习曲线估计约为 30 例。
RDN 是 LDN 的安全替代方法，供体发病率可接受，即使在 RDN 学习曲线的早期阶段，也不会对受者结局产生负面影响。与传统腹腔镜相比，外科医生对机器人方法的偏好需要进一步审查，以改善人体工程学和手术效率。
