Orthotopic kidney transplantation (KT) has been proposed as an option for patients ineligible for heterotopic KT. In this scenario, orthotopic robot-assisted KT (oRAKT) represents a novel, minimally invasive alternative to the open approach. Here we describe the largest oRAKT series of patients, with a focus on the surgical technique, perioperative surgical outcomes, and functional results. We queried prospectively maintained databases from three referral centers to identify patients who underwent oRAKT and evaluated surgical and functional outcomes. Overall, 16 oRAKT procedures were performed between January 2020 and August 2023. These involved four donors after cardiovascular death, five donors after brain death, and seven living donors. All oRAKT procedures were carried out in the left renal fossa. The indication for oRAKT was extensive calcification of the external iliac vessels (100%), frequently associated with prior KT (31%). The median operative time was 295 min (interquartile range [IQR] 268–360) and the median rewarming time 48 min (IQR 40–54). Conversion to open surgery occurred in two cases (12%), and delayed graft function was observed in two cases (12%). Postoperative complications occurred in 11 patients (69%) and three (18%) experienced Clavien-Dindo grade >II complications. At median follow-up of 9 mo (IQR 7–17), 14 patients had a functioning graft and median creatinine of 1.49 mg/dl (IQR 1.36–1.72). Although oRAKT is a challenging procedure, it represents a feasible option for individuals ineligible for heterotopic KT and yields favorable perioperative and mid-term functional outcomes. We evaluated outcomes of orthotopic robot-assisted kidney transplantation (KT), in which the native kidney is removed and the donor kidney is transplanted into its place, in patients who are not eligible for heterotopic KT, in which the native kidney is left in place and the donor kidney is transplanted into a new location. We found that robot-assisted surgery is a safe and feasible alternative to traditional open surgery for orthotopic KT.

中文翻译：

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原位机器人辅助肾移植：手术技术和初步结果


原位肾移植 (KT) 已被提议作为不适合异位 KT 的患者的一种选择。在这种情况下，原位机器人辅助 KT（oRAKT）代表了开放式方法的一种新颖的微创替代方案。在这里，我们描述了最大的 oRAKT 系列患者，重点关注手术技术、围手术期手术结果和功能结果。我们查询了三个转诊中心前瞻性维护的数据库，以确定接受 oRAKT 的患者并评估手术和功能结果。总体而言，2020 年 1 月至 2023 年 8 月期间进行了 16 例 oRAKT 手术。其中涉及 4 名心血管死亡后的捐赠者、5 名脑死亡后的捐赠者和 7 名活体捐赠者。所有 oRAKT 手术均在左肾窝进行。 oRAKT 的适应症是髂外血管广泛钙化 (100%)，通常与先前的 KT (31%) 相关。中位手术时间为 295 分钟（四分位距 [IQR] 268-360），中位复温时间为 48 分钟（IQR 40-54）。 2 例（12%）中转开腹手术，2 例（12%）出现移植功能延迟。 11 名患者 (69%) 发生术后并发症，其中 3 名患者 (18%) 出现 Clavien-Dindo 级 > II 级并发症。中位随访 9 个月（IQR 7-17）时，14 名患者的移植物功能正常，中位肌酐为 1.49 mg/dl（IQR 1.36-1.72）。尽管 oRAKT 是一项具有挑战性的手术，但它对于不适合异位 KT 的个体来说是一种可行的选择，并产生良好的围手术期和中期功能结果。 我们评估了原位机器人辅助肾移植 (KT) 的结果，其中原生肾脏被移除，供体肾脏被移植到其位置，对于不符合异位 KT 条件的患者，其中原生肾脏保留在原位供体肾脏被移植到新位置。我们发现机器人辅助手术是原位 KT 传统开放手术的安全可行的替代方案。