O'Connor-Cordova Mario A, Ortega-Macias Alan G, Sancen-Herrera Juan P, Altamirano-Lamarque Francisco, Del Toro Alexis Vargas, Del Campo Andres Inzunza Martin, Canal-Zarate Pia, Peddinani Bharat Kumar, Gonzalez-Zorrilla Fernando, O'Connor Juarez Mario
Escuela de Medicina del Tecnológico de Monterrey, Av. Morones Prieto 3000, Monterrey, Nuevo León, Mexico.
Escuela de Medicina del Tecnológico de Monterrey, Av. Morones Prieto 3000, Monterrey, Nuevo León, Mexico.
Transplant Rev (Orlando). 2023 Dec;37(4):100789. doi: 10.1016/j.trre.2023.100789. Epub 2023 Aug 11.
Renal transplant is the standard of care for patients with end-stage renal disease (ESRD). Robotic-assisted kidney transplant (RAKT) has emerged as a safe minimally invasive approach with a lower complication rate than open kidney transplant (OKT). Concerns regarding ischemia times and graft function are still a matter of debate.
Following PRISMA guidelines and PROSPERO registration CRD42023413774, a systematic review was performed in March 2023 on RAKT compared to OKT. Primary outcomes of interest were surgical times, ischemia times, blood loss, complication rates, and graft function. Data were analyzed using R version 4.2.2.
A total of nine studies comparing living donor RAKT to living donor OKT were included, totaling 1477 patients, out of which 508 underwent RAKT and 969 OKT. RAKT cases were highly selected as depicted in the manuscript. Cumulative analysis showed significantly longer total ischemic time (MD = 16.51; 95% CI = [9.86-23.16]) and rewarming ischemia time (MD = 11.24; 95% CI = [-0.46-22.01]) in RAKT group. No differences were found in total procedure time and time to complete anastomoses. Blood loss and transfusion rate were lower in RAKT group (MD = -53.68; 95% CI = [-89.78; -17.58]) and (RR = 0.29; 95% CI = [0.14; 0.57]), respectively. The meta-analysis revealed a lower rate of surgical site infection (SSI) (RR = 0.31; 95% CI = [0.19-0.52]) and symptomatic lymphocele (RR = 0.16; 95% CI = [0.06-0.43]) in RAKT. No difference in ileus rate was found. Pain scores were significantly lower in the RAKT group (MD = -1.14; 95% CI = [-1.59 - -0.69]; p ≤0.01). No difference in length of stay and hospital readmission were evidenced. Delayed graft function (DGF) and acute rejection rates were not different between interventions groups (RR =1.23; 95% CI = [0.40-3.74]) and (RR =0.96; 95% CI = [0.55-1.70]), respectively. No difference between groups in early graft outcomes are evident.
Our analysis suggests that RAKT is a minimally invasive, safe, and feasible procedure. It is associated with a lower complication rate and similar intraoperative, perioperative, and postoperative outcomes. Further quality studies are needed to confirm these findings.
肾移植是终末期肾病（ESRD）患者的标准治疗方法。机器人辅助肾移植（RAKT）已成为一种安全的微创方法，其并发症发生率低于开放性肾移植（OKT）。关于缺血时间和移植肾功能的问题仍存在争议。
按照PRISMA指南和PROSPERO注册编号CRD42023413774，于2023年3月对RAKT与OKT进行了系统评价。感兴趣的主要结局指标为手术时间、缺血时间、失血量、并发症发生率和移植肾功能。使用R版本4.2.2对数据进行分析。
共纳入9项比较活体供体RAKT与活体供体OKT的研究，共计1477例患者，其中508例行RAKT，969例行OKT。如手稿中所述，RAKT病例经过高度筛选。累积分析显示，RAKT组的总缺血时间（MD = 16.51；95%CI = [9.86 - 23.16]）和复温缺血时间（MD = 11.24；95%CI = [-0.46 - 22.01]）显著更长。总手术时间和完成吻合的时间未发现差异。RAKT组的失血量和输血率较低，分别为（MD = -53.68；95%CI = [-89.78；-17.58]）和（RR = 0.29；95%CI = [0.14；0.57]）。荟萃分析显示，RAKT的手术部位感染（SSI）发生率较低（RR = 0.31；95%CI = [0.19 - 0.52]），有症状性淋巴囊肿发生率也较低（RR = 0.16；95%CI = [0.06 - 0.43]）。肠梗阻发生率未发现差异。RAKT组的疼痛评分显著更低（MD = -1.14；95%CI = [-1.59 - -0.69]；p≤0.01）。住院时间和再次入院情况未发现差异。干预组之间的移植肾功能延迟（DGF）和急性排斥反应发生率无差异，分别为（RR = 1.23；95%CI = [0.40 - 3.74]）和（RR = 0.96；95%CI = [0.55 - 1.70]）。各组早期移植结局无明显差异。
我们的分析表明，RAKT是一种微创、安全且可行的手术。它与较低的并发症发生率以及相似的术中、围手术期和术后结局相关。需要进一步的高质量研究来证实这些发现。
