Study: Robotic kidney transplantation is safe and feasible
Tuesday, January 30, 2018
Robotic kidney transplantation can provide speedy recovery, low complication rates and excellent graft function, according to a new study.
A team led by Alberto Breda, M.D., hoped to evaluate perioperative outcomes and early postoperative surgical outcomes of patients who undergo robot-assisted kidney transplantation (RAKT). The researchers enrolled 75 adult males and 45 adult females from eight European centers who had undergone the procedure.
Of the 120 participants, 118 received a kidney from a living donor. The median age of participants at the time of surgery was 43 years; participants had a median dialysis duration of 365 days and a minimum follow-up period of one year.
The researchers provided the details of their findings in the February issue of European Urology. They list the median operative and vascular suture time as 250 and 38 minutes, respectively, and the median estimated blood loss as 150 mL. Total median ischemia time was 89.5 minutes.
The investigators reported the median postoperative estimated glomerular filtration rate (GFR) on postoperative days 1, 3, 7 and 30 was 21.2, 45.0, 52.6 and 58.0 mL/min/1.73 m2, respectively. Five participants experienced delayed graft function. There was one case of wound infection, three cases of ileus, and four cases of bleeding. The patients experienced no major intraoperative complications, but two patients did end up requiring open conversion.
The scientists concluded their study by saying that use of a robotic technique "also has low complication rates in selected cases and yields excellent graft function."
The team noted that all of the surgical teams involved in the study had extensive expertise in kidney transplant surgery and robotic surgery. The surgeons had practiced the robotic technique on animal models under the guidance of a more experienced RAKT surgeon prior to using it on human patients. The proctor supervised the surgeons during training and oversaw the surgeons when they performed their first case or cases in their own medical centers.
Limitations of the study included possible bias in the selection process. While the eight centers participating in the study are high volume, the researchers included only a limited number of recipients in the study. The investigators attribute the limited number of recipients to the inclusion and exclusion criteria along with the cost limitation of the procedure. Patient preference also played a role.
Other limitations include the lack of a control group of participants who underwent open kidney transplant from a living donor, and the issue that the centers enrolled patients into the study at different times.
Nevertheless, robotic surgery offers several advantages largely relating to the use of articulated instruments, superb magnification, a three-dimensional view and good surgeon ergonomics.
RAKT may provide an added benefit for patients with end-stage renal disease (ESRD); the minimally invasive approach of RAKT can reduce infection risk in these immunocompromised and fragile patients.
In an editorial accompanying the study, Akshay Sood, M.D., and Mani Menon, M.D., of the Vattikuti Urology Institute at Henry Ford Hospital in Detroit said, “The authors are congratulated for successfully undertaking this study and demonstrating that robotic kidney transplantation can be safely adopted by surgeons of varying robotic experience via a structured preclinical and clinical mentorship program.”
The authors also called the field of transplantation "a testament to human imagination and love," noting the procedure's 100-year history of sacrifice, failure and success.
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