Department of Urology, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
Recanati/Miller Transplantation Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA.
J Endourol. 2024 Feb;38(2):136-141. doi: 10.1089/end.2023.0364.
To compare the intra- and postoperative outcomes of single-port robotic donor nephrectomies (SP RDNs) and laparoscopic donor nephrectomies (LDNs). We retrospectively reviewed our institutional database for patients who received LDN or SP RDN between September 2020 and December 2022. Donor baseline characteristics, intraoperative outcomes, postoperative outcomes, and recipient renal function were extracted and compared between LDN and SP RDN. SP RDN learning curve analysis based on operative time and graft extraction time was performed using cumulative sum analysis. One hundred forty-four patients underwent LDN and 32 patients underwent SP RDN. LDN and SP RDN had similar operative times (LDN: 190.3 ± 28.0 minutes, SP RDN: 194.5 ± 35.1 minutes, = 0.3253). SP RDN patients had significantly greater extraction times (LDN: 83.2 ± 40.3 seconds, SP RDN: 204.1 ± 52.2 seconds, < 0.0001) and warm ischemia times (LDN: 145.1 ± 61.7 seconds, SP RDN: 275.4 ± 65.6 seconds, < 0.0001). There were no differences in patient subjective pain scores, inpatient opioid usage, or Clavien-Dindo II+ complications. Short- and medium-term postoperative donor and recipient renal function were also similar between the groups. SP RDN graft extraction time and total operative time learning curves were achieved at case 27 and 13, respectively. SP RDN is a safe and feasible alternative to LDN that minimizes postoperative abdominal incisional scars and has a short learning curve. Future randomized prospective clinical trials are needed to confirm the findings of this study and to identify other potential benefits and drawbacks of SP RDNs.
比较单端口机器人供肾切除术(SP RDN)和腹腔镜供肾切除术(LDN)的围手术期结果。我们回顾性分析了 2020 年 9 月至 2022 年 12 月期间接受 LDN 或 SP RDN 的患者的机构数据库。提取并比较了 LDN 和 SP RDN 之间的供体基线特征、术中结果、术后结果和受体肾功能。使用累积和分析对基于手术时间和移植物提取时间的 SP RDN 学习曲线进行分析。144 例患者接受 LDN,32 例患者接受 SP RDN。LDN 和 SP RDN 的手术时间相似(LDN:190.3±28.0 分钟,SP RDN:194.5±35.1 分钟, = 0.3253)。SP RDN 患者的提取时间显著更长(LDN:83.2±40.3 秒,SP RDN:204.1±52.2 秒, < 0.0001)和热缺血时间更长(LDN:145.1±61.7 秒,SP RDN:275.4±65.6 秒, < 0.0001)。两组患者的主观疼痛评分、住院期间阿片类药物使用或 Clavien-Dindo II+并发症无差异。两组术后短期和中期供体和受体肾功能也相似。SP RDN 移植物提取时间和总手术时间学习曲线分别在第 27 例和第 13 例时达到。SP RDN 是一种安全可行的 LDN 替代方法,可最大程度减少术后腹部切口疤痕,且学习曲线较短。需要未来的随机前瞻性临床试验来证实本研究的结果,并确定 SP RDN 的其他潜在益处和缺点。