Intracorporeal Versus Extracorporeal Robot-assisted Kidney Autotransplantation: Experience of the ERUS RAKT Working Group.
Autotransplantation
Extracorporeal
Intracorporeal
Kidney
Kidney autotransplantation
Outcome
Robotic surgery
Technology
Journal
European urology
ISSN: 1873-7560
Titre abrégé: Eur Urol
Pays: Switzerland
ID NLM: 7512719
Informations de publication
Date de publication:
Feb 2022
Feb 2022
Historique:
received:
04
05
2021
accepted:
22
07
2021
pubmed:
17
8
2021
medline:
19
4
2022
entrez:
16
8
2021
Statut:
ppublish
Résumé
Kidney autotransplantation is a useful technique to be reserved for cases in which kidney function is compromised by a complex anatomical configuration, such as long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction. Robot-assisted kidney autotransplantation (RAKAT) presents a novel, minimally invasive, and highly accurate approach. The aim of this study is to present the largest cohort of patients who underwent either extracorporeal (eRAKAT) or intracorporeal (iRAKAT) RAKAT, to confirm safety and feasibility and to compare the two approaches. We retrospectively analyzed prospectively followed patients undergoing eRAKAT and totally intracorporeal RAKAT in a total of three institutions. Extracorporeal RAKAT and iRAKAT. Surgical and functional outcomes of patients subjected to eRAKAT and iRAKAT were measured. Between January 2017 and February 2021, 29 patients underwent RAKAT: 15 eRAKAT and 14 iRAKAT. No statistical difference in the preoperative data was recorded. The analysis of intraoperative variables showed a statistically significant difference between eRAKAT and iRAKAT in cold ischemia time (median [interquartile range {IQR}]: 151 [125-199] vs 27.5 [20-55]; p < 0.001) and total ischemia time (median [IQR]: 196.2 [182-241] vs 81.5 [73-88]; p < 0.001). However, faster renal function recovery in favor of eRAKAT was observed during the first 90 d, with comparable renal function at 1 yr. The 90-d Clavien-Dindo >2 complications were 13.8%. It is important to stress that RAKAT, and above all iRAKAT, should be performed by surgeons with experience in robotic renal, vascular, and transplant surgery. Both eRAKAT and iRAKAT represent promising minimally invasive techniques in selected cases with acceptable ischemia time and comparable long-term operative outcomes. In selected patients, both extra- and intracorporeal robot-assisted kidney autotransplantation represent valid alternatives in case of long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction.
Sections du résumé
BACKGROUND
BACKGROUND
Kidney autotransplantation is a useful technique to be reserved for cases in which kidney function is compromised by a complex anatomical configuration, such as long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction. Robot-assisted kidney autotransplantation (RAKAT) presents a novel, minimally invasive, and highly accurate approach.
OBJECTIVE
OBJECTIVE
The aim of this study is to present the largest cohort of patients who underwent either extracorporeal (eRAKAT) or intracorporeal (iRAKAT) RAKAT, to confirm safety and feasibility and to compare the two approaches.
DESIGN, SETTING, AND PARTICIPANTS
METHODS
We retrospectively analyzed prospectively followed patients undergoing eRAKAT and totally intracorporeal RAKAT in a total of three institutions.
SURGICAL PROCEDURE
METHODS
Extracorporeal RAKAT and iRAKAT.
MEASUREMENTS
METHODS
Surgical and functional outcomes of patients subjected to eRAKAT and iRAKAT were measured.
RESULTS AND LIMITATIONS
CONCLUSIONS
Between January 2017 and February 2021, 29 patients underwent RAKAT: 15 eRAKAT and 14 iRAKAT. No statistical difference in the preoperative data was recorded. The analysis of intraoperative variables showed a statistically significant difference between eRAKAT and iRAKAT in cold ischemia time (median [interquartile range {IQR}]: 151 [125-199] vs 27.5 [20-55]; p < 0.001) and total ischemia time (median [IQR]: 196.2 [182-241] vs 81.5 [73-88]; p < 0.001). However, faster renal function recovery in favor of eRAKAT was observed during the first 90 d, with comparable renal function at 1 yr. The 90-d Clavien-Dindo >2 complications were 13.8%. It is important to stress that RAKAT, and above all iRAKAT, should be performed by surgeons with experience in robotic renal, vascular, and transplant surgery.
CONCLUSIONS
CONCLUSIONS
Both eRAKAT and iRAKAT represent promising minimally invasive techniques in selected cases with acceptable ischemia time and comparable long-term operative outcomes.
PATIENT SUMMARY
RESULTS
In selected patients, both extra- and intracorporeal robot-assisted kidney autotransplantation represent valid alternatives in case of long ureteral strictures and renal vascular anomalies not suitable for in situ reconstruction.
Identifiants
pubmed: 34393012
pii: S0302-2838(21)01926-6
doi: 10.1016/j.eururo.2021.07.023
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
168-175Commentaires et corrections
Type : ErratumIn
Informations de copyright
Copyright © 2021 European Association of Urology. Published by Elsevier B.V. All rights reserved.