Robotic kidney transplantation.
Giuseppe BasileAlessio PecoraroAndrea GallioliAngelo TerritoCamille BerquinJorge RobalinoAlejandra BravoJorge HuguetÓscar Rodriguez-FabaPavel GavrilovCarmen FacundoLluís GuiradoJosep Maria GayaJoan PalouAlberto BredaPublished in: Nature reviews. Urology (2024)
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.
Keyphrases
- kidney transplantation
- minimally invasive
- end stage renal disease
- robot assisted
- chronic kidney disease
- peritoneal dialysis
- urinary tract
- healthcare
- primary care
- quality improvement
- emergency department
- insulin resistance
- type diabetes
- climate change
- cardiovascular disease
- metabolic syndrome
- early onset
- ejection fraction
- drug induced
- diabetic rats
- newly diagnosed
- high glucose
- high fat diet induced
- body mass index
- oxidative stress
- smoking cessation
- percutaneous coronary intervention
- weight gain
- adipose tissue
- physical activity
- electronic health record
- combination therapy