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Territo A, Afferi L, Musquera M, Gaya Sopena JM, Pecoraro A, Campi R, Gallioli A, Etcheverry B, Prudhomme T, Vangeneugden J, Ortved M, Røder A, Zeuschner P, Volpe A, Garcia-Baquero R, Kocak B, Mirza I, Stockle M, Canda E, Fornara P, Rohrsted M, Doumerc N, Decaestecker K, Serni S, Vigues F, Alcaraz A, Breda A. Robot-assisted Kidney Transplantation: The 8-year European Experience. Eur Urol 2025; 87:468-475. [PMID: 39794184 DOI: 10.1016/j.eururo.2024.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2024] [Revised: 11/30/2024] [Accepted: 12/13/2024] [Indexed: 01/13/2025]
Abstract
BACKGROUND AND OBJECTIVE Evidence regarding perioperative results and long-term functional outcomes of robotic-assisted kidney transplantation (RAKT) is limited. We evaluated perioperative surgical results and long-term functional outcomes of RAKT in patients receiving kidney transplants from living donors. METHODS This retrospective analysis is based on a prospective multicenter cohort study conducted from July 2015 to October 2023 across ten European centers. A total of 624 patients who underwent heterotopic RAKT from living donors were included, excluding those who received orthotopic RAKT. The primary outcomes measured were long-term renal function, perioperative complications, and survival rates. Renal function was assessed with the estimated glomerular filtration rate (eGFR). The Clavien-Dindo classification (CDC) was used to describe early (within 30 d) and late (from 31 to 90 d) postoperative complications. The probabilities of dialysis, graft nephrectomies, and any-cause mortality during follow-up were reported in terms of the 5-yr cumulative incidence. KEY FINDINGS AND LIMITATIONS A total of 624 patients with a median age of 35 yr (interquartile range [IQR]: 26-52) underwent RAKT. Preemptive RAKT was performed in 52% of cases, and the majority (84%) had the transplant in the right iliac fossa. The median operative time was 210 min (IQR: 180-262), with a rewarming time of 43 min (IQR: 38-50). Intraoperative complications were rare (1.1%), and postoperative graft nephrectomy occurred in 1.9% of patients. High-grade (CDC grade ≥3) early and late postoperative complications were observed in 7.7% and 2.3% of patients, respectively. Rates of incisional hernias, ureteral stenosis, and arterial stenosis were 1.4%, 1.1%, and 0.2%, respectively. The median eGFR values were 19, 52, and 53 ml/min/1.73 m2 on the 1st postoperative day, on the 7th postoperative day, and at 6 mo, respectively. Over a median follow-up of 23 mo (IQR: 6-49), 17 patients received dialysis, 11 patients underwent graft nephrectomy, and four patients died. None of the deaths were due to RAKT. The main limitation is the absence of a comparator group. CONCLUSIONS AND CLINICAL IMPLICATIONS With the largest experience worldwide on RAKT, we confirm the perioperative safety and excellent long-term functional outcomes of this procedure. Given the benefits of a minimally invasive robotic approach, these findings support the broader adoption of RAKT as a viable option for kidney transplantation.
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Affiliation(s)
- Angelo Territo
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain.
| | - Luca Afferi
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Mireia Musquera
- Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya Sopena
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Alessio Pecoraro
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Riccardo Campi
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
| | - Begoña Etcheverry
- Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - Thomas Prudhomme
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Joris Vangeneugden
- Department of Urology, University Hospital Ghent, Ghent, Belgium (ERN eUROGEN accredited center)
| | - Milla Ortved
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Andreas Røder
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Philip Zeuschner
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Alessandro Volpe
- Division of Urology, Department of Translational Medicine, University of Eastern Piedmont, Maggiore della Carità Hospital, Novara, Italy
| | - Rodrigo Garcia-Baquero
- Kidney Transplant Unit, Urology Department, Hospital Universitario Puerta del Mar, Cádiz, Spain
| | - Burak Kocak
- Koç University Hospital Organ Transplant Center, İstanbul, Turkey; Department of Urology, Koç University School of Medicine, İstanbul, Turkey
| | - Idu Mirza
- Department of Surgery, Academic Medical Center Amsterdam, Amsterdam, The Netherlands
| | - Michael Stockle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Erdem Canda
- Koç University Hospital Organ Transplant Center, İstanbul, Turkey; Department of Urology, Koç University School of Medicine, İstanbul, Turkey
| | - Paolo Fornara
- Clinic of Urology and Transplantation, Medical Faculty of Martin Luther University Halle-Wittenberg, Halle/Saale, Germany
| | - Malene Rohrsted
- Department of Urology, Centre for Cancer and Organ Diseases, Copenhagen University Hospital - Rigshospitalet, Copenhagen, Denmark
| | - Nicolas Doumerc
- Department of Urology and Renal Transplantation, University Hospital of Rangueil, Toulouse, France
| | - Karel Decaestecker
- Department of Urology, University Hospital Ghent, Ghent, Belgium (ERN eUROGEN accredited center)
| | - Sergio Serni
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy; Unit of Urological Minimally Invasive, Robotic Surgery and Kidney Transplantation, Careggi Hospital, University of Florence, Florence, Italy
| | - Francesc Vigues
- Department of Urology, Hospital Universitari de Bellvitge, Le'Hospitalet de Llobregat, Barcelona, Spain
| | - Antonio Alcaraz
- Department of Urology, Hospital Clinic-IDIBAPS, University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universitat Autonoma de Barcelona, Barcelona, Spain
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Basile G, Pecoraro A, Gallioli A, Territo A, Berquin C, Robalino J, Bravo A, Huguet J, Rodriguez-Faba Ó, Gavrilov P, Facundo C, Guirado L, Gaya JM, Palou J, Breda A. Robotic kidney transplantation. Nat Rev Urol 2024; 21:521-533. [PMID: 38480898 DOI: 10.1038/s41585-024-00865-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/16/2024] [Indexed: 09/06/2024]
Abstract
Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patients with obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach.
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Affiliation(s)
- Giuseppe Basile
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy
| | - Alessio Pecoraro
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy
| | - Andrea Gallioli
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Camille Berquin
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
- Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre, Ghent, Belgium
| | - Jorge Robalino
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alejandra Bravo
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Jorge Huguet
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Óscar Rodriguez-Faba
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Pavel Gavrilov
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Carmen Facundo
- Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Lluis Guirado
- Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| | - Josep Maria Gaya
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Joan Palou
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain.
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Territo A, Bajeot AS, Mesnard B, Campi R, Pecoraro A, Hevia V, Piana A, Doumerc N, Breda A, Boissier R, Prudhomme T. Open versus robotic-assisted kidney transplantation: A systematic review by the European Association of Urology (EAU) - Young Academic Urologists (YAU) Kidney Transplant Working Group. Actas Urol Esp 2023; 47:474-487. [PMID: 36965855 DOI: 10.1016/j.acuroe.2023.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2023] [Revised: 01/24/2023] [Accepted: 01/25/2023] [Indexed: 03/27/2023]
Abstract
INTRODUCTION In the last 20 years, robotic assisted procedures were evaluated in the field of kidney transplantation to provide a mini-invasive approach for this particularly fragile population. As a relatively new issue, few studies compared open kidney transplantation (OKT) and robotic-assisted kidney transplantation (RAKT), mostly in small cohorts. To improve current knowledge, we wanted here to gather comparative data of OKT vs RAKT in a systematic review. METHODS A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting post-operative outcomes of RAKT versus OKT. RESULTS A total of 2136 patients in 13 studies were included. Median recipient age was 42.6 years (OKT: 43.5 years and RAKT: 40.3 years). Median preemptive kidney transplantation rate was 27.1 % (OKT: 23.3 % and RAKT: 33.2 %). Median total operative time and rewarming were respectively: 235 and 49 min in OKT population; 250 and 60 min in RAKT population. Post-operative complications rates were: 26.2 % in OKT population and 17.8 % in RAKT population. Delayed graft function rates were: 4.9 % in OKT population and 2.3 in RAKT population. Mid-term functional outcomes, patient and graft survival were similar in OKT and RAKT population. CONCLUSION This systematic review showed that RAKT may be associated with a lower incidence of delayed graft function and post-operative surgical complications and similar mid-term functional outcomes, patient and graft survival, compared to OKT for end-stage renal disease patients.
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Affiliation(s)
- A Territo
- Uro-oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
| | - A S Bajeot
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France
| | - B Mesnard
- Department of Urology and Kidney Transplantation, Nantes University Hospital, Nantes, France
| | - R Campi
- Department of Urology, Florence University Hospital, Florence, Italy
| | - A Pecoraro
- Department of Urology, Florence University Hospital, Florence, Italy
| | - V Hevia
- Department of Urology, University Hospital Ramón y Cajal, Madrid, Spain
| | - A Piana
- Department of Urology, San Luigi Gonzaga Hospital, University of Turin, Orbassano, Turin, Italy
| | - N Doumerc
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France
| | - A Breda
- Uro-oncology and Kidney Transplant Unit, Department of Urology at "Fundació Puigvert" Hospital, Autonoma University of Barcelona, Barcelona, Spain
| | - R Boissier
- Department of Urology, La Conception University Hospital, Marseille, France
| | - T Prudhomme
- Department of Urology and Kidney Transplantation, Rangueil University Hospital, Toulouse, France.
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Grammens J, Schechter MY, Desender L, Claeys T, Sinatti C, VandeWalle J, Vermassen F, Raes A, Vanpeteghem C, Prytula A, Silay MS, Breda A, Decaestecker K, Spinoit AF. Pediatric Challenges in Robot-Assisted Kidney Transplantation. Front Surg 2021; 8:649418. [PMID: 33842532 PMCID: PMC8030256 DOI: 10.3389/fsurg.2021.649418] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/01/2021] [Indexed: 12/17/2022] Open
Abstract
Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical–material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.
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Affiliation(s)
- Julien Grammens
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Michal Yaela Schechter
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Liesbeth Desender
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Tom Claeys
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Céline Sinatti
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Johan VandeWalle
- Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Frank Vermassen
- Department of Vascular and Thoracic Surgery, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Ann Raes
- Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Caroline Vanpeteghem
- Department of Anesthesiology and Perioperative Medicine, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Agnieszka Prytula
- Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Mesrur Selçuk Silay
- Division of Pediatric Urology, Department of Urology, Biruni University, Istanbul, Turkey
| | - Alberto Breda
- Department of Urology, Fundació Puigvert, Universidad Autonoma de Barcelona, Barcelona, Spain
| | - Karel Decaestecker
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
| | - Anne-Françoise Spinoit
- Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University, Ghent, Belgium
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