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机器人辅助肾移植术单中心初步经验

张明晓, 丁振山, 王建峰, 等. 机器人辅助肾移植术单中心初步经验[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2023261
引用本文: 张明晓, 丁振山, 王建峰, 等. 机器人辅助肾移植术单中心初步经验[J]. 器官移植. doi: 10.3969/j.issn.1674-7445.2023261
Zhang Mingxiao, Ding Zhenshan, Wang Jianfeng, et al. Preliminary experience of robotic-assisted kidney transplantation in a single center[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2023261
Citation: Zhang Mingxiao, Ding Zhenshan, Wang Jianfeng, et al. Preliminary experience of robotic-assisted kidney transplantation in a single center[J]. ORGAN TRANSPLANTATION. doi: 10.3969/j.issn.1674-7445.2023261

机器人辅助肾移植术单中心初步经验

doi: 10.3969/j.issn.1674-7445.2023261
基金项目: 中央高水平医院临床科研业务费资助(2022-NHLHCRF-LX-03-0302、2023-NHLHCRF-LXYZ-04);中日友好医院“菁英计划”人才培育工程资助(ZRJY2023-QM30)
详细信息
    作者简介:
    通讯作者:

    周晓峰(ORCID 0000-0002-0513-9234),主任医师,博士研究生导师,研究方向为泌尿外科及肾移植,Email:zxfzryy@163.com

  • 中图分类号: R617, R692

Preliminary experience of robotic-assisted kidney transplantation in a single center

More Information
  • 摘要:   目的  探索机器人辅助肾移植(RAKT)的安全性、有效性及可行性。  方法  收集行肾移植术的16例患者资料,其中8例采用RAKT(RAKT组),接受同一供者对侧肾脏的8例患者采用开放肾移植术(OKT组)。对比两组受者围手术期结果及移植肾功能恢复情况。  结果  所有患者均成功完成手术,RAKT组无患者在术中转开放手术。RAKT组手术时间长于OKT(P=0.015)。两组受者术前血清肌酐及出院时血清肌酐差异无统计学意义(均为P>0.05)。OKT组1例受者出现移植物功能延迟恢复(DGF),其余患者均未出现围手术期并发症。两组术后短期肾功能恢复差异无统计学意义(P>0.05)。  结论   RAKT术后恢复与OKT相当,对于肾移植手术经验丰富的团队而言,RAKT是一种安全有效的手术方式,可以尝试开展。

     

  • 图  1  供肾包裹及受者体位

    注:A图为使用双层无菌塑料肾袋包裹供肾;B图为RAKT术中患者体位。

    Figure  1.  Donor kidney encapsulation and position of recipient

    图  2  RAKT手术过程

    注:A图为建立肾巢;B图为右髂外血管骨骼化;C图为静脉吻合;D图为动脉吻合;E图为开放循环;F图为输尿管膀胱吻合;G图为完全腹膜外化;H图为部分腹膜外化。

    Figure  2.  Surgical procedures of RAKT

    图  3  两组受者术后血清肌酐变化趋势

    Figure  3.  Trend of postoperative serum creatinine changes in two groups of recipients

    表  1  两组受者一般资料及围手术期结果比较

    Table  1.   Comparison of general date and perioperative outcomes between recipients of two groups

    指标 RAKT组(n=8) OKT组(n=8) P
    年龄($\overline x $±s,岁) 40±14 50±10 0.120
    性别(n 1.000
     男 8 7
     女 0 1
    是否透析(n 1.000
     是 6 7
     否 2 1
    透析时间($\overline x $±s,月) 7.0(0.3,11.8) 8.5(1.8,15.8) 0.597
    手术时间[MP25,P75),min] 295(287,370) 242(189,285) 0.015
    术中出血量[MP25,P75),mL] 100(100,200) 100(100,138) 0.809
    术后住院时间($\overline x $±s,d) 15±3 15±4 0.787
    术前血清肌酐($\overline x $±s,μmol/L) 915±179 1 145±288 0.075
    出院时血清肌酐($\overline x $±s,μmol/L) 108±33 133±60 0.309
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  • [1] TZVETANOV IG, TULLA KA, DI COCCO P, et al. Robotic kidney transplant: the modern era technical revolution[J]. Transplantation, 2022, 106(3): 479-488. DOI: 10.1097/TP.0000000000003881.
    [2] HOZNEK A, ZAKI SK, SAMADI DB, et al. Robotic assisted kidney transplantation: an initial experience[J]. J Urol, 2002, 167(4): 1604-1606. DOI: 10.1016/S0022-5347(05)65162-2.
    [3] GIULIANOTTI P, GORODNER V, SBRANA F, et al. Robotic transabdominal kidney transplantation in a morbidly obese patient[J]. Am J Transplant, 2010, 10(6): 1478-1482. DOI: 10.1111/j.1600-6143.2010.03 116.x.
    [4] MENON M, ABAZA R, SOOD A, et al. Robotic kidney transplantation with regional hypothermia: evolution of a novel procedure utilizing the IDEAL guidelines (IDEAL phase 0 and 1)[J]. Eur Urol, 2014, 65(5): 1001-1009. DOI: 10.1016/j.eururo.2013.11.011.
    [5] MENON M, SOOD A, BHANDARI M, et al. Robotic kidney transplantation with regional hypothermia: a step-by-step description of the Vattikuti Urology Institute-Medanta technique (IDEAL phase 2a)[J]. Eur Urol, 2014, 65(5): 991-1000. DOI: 10.1016/j.eururo.2013.12.006.
    [6] AHLAWAT R, SOOD A, JEONG W, et al. Robotic kidney transplantation with regional hypothermia versus open kidney transplantation for patients with end stage renal disease: an ideal stage 2B study[J]. J Urol, 2021, 205(2): 595-602. DOI: 10.1097/JU.0000000000001368.
    [7] LI MARZI V, PECORARO A, GALLO ML, et al. Robot-assisted kidney transplantation: is it getting ready for prime time?[J]. World J Transplant, 2022, 12(7): 163-174. DOI: 10.5500/wjt.v12.i7.163.
    [8] KAOUK J, ELTEMAMY M, AMINSHARIFI A, et sl. Initial experience with single-port robotic-assisted kidney transplantation and autotransplantation[J]. Eur Urol, 2021, 80(3): 366-373. DOI: 10.1016/j.eururo.2021.03.002.
    [9] MUSQUERA FELIP M, AJAMI FARDOUN T, PERI CUSI L, et al. Technique description and outcomes of robotic transvaginal-assisted living donor kidney transplantation[J]. Urol Int, 2021, 105(1/2): 148-154. DOI: 10.1159/000511756.
    [10] SLAGTER JS, OUTMANI L, TRAN KTCK, et al. Robot-assisted kidney transplantation as a minimally invasive approach for kidney transplant recipients: a systematic review and meta-analyses[J]. Int J Surg, 2022, 99: 106264. DOI: 10.1016/j.ijsu.2022.106264.
    [11] 王昕凝, 祖强, 祝强, 等. 机器人辅助腹腔镜肾移植术1例报道并文献复习[J]. 微创泌尿外科杂志, 2018, 7(3): 159-162. DOI: 10.19558/j.cnki.10-1020/r.2018.03.004.

    WANG XN, ZU Q, ZHU Q, et al. Surgical outcomes of robotic-assisted kidney transplantation in end-stage renal disease treatment (1 case report)[J]. J Mini Invasive Urol, 2018, 7(3): 159-162. DOI: 10.19558/j.cnki.10-1020/r.2018.03.004.
    [12] 谭顺成, 崔建春, 宋永琳, 等. 机器人辅助腹腔镜肾移植术初步经验(附22例报告)[J]. 微创泌尿外科杂志, 2021, 10(3): 157-162. DOI: 10.19558/j.cnki.10-1020/r.2021.03.003.

    TAN SC, CUI JC, SONG YL, et al. Preliminary experience of robot-assisted laparoscopic kidney transplantation (report of 22 cases)[J]. J Mini Invasive Urol, 2021, 10(3): 157-162. DOI: 10.19558/j.cnki.10-1020/r.2021.03.003.
    [13] 赵鉴明, 范阳, 陈欣, 等. 机器人辅助腹腔镜同种异体肾移植术的早中期结果[J]. 微创泌尿外科杂志, 2021, 10(2): 80-83. DOI: 10.19558/j.cnki.10-1020/r.2021.02.002.

    ZHAO JM, FAN Y, CHEN X, et al. Early and mid-term results of robot-assisted laparoscopic kidney transplantation[J]. J Mini Invasive Urol, 2021, 10(2): 80-83. DOI: 10.19558/j.cnki.10-1020/r.2021.02.002.
    [14] 钟晓, 兰卫华, 王洛夫, 等. 机器人肾移植术围手术期疗效分析[J]. 陆军军医大学学报, 2022, 44(18): 1862-1866. DOI: 10.16016/j.2097-0927.202204035.

    ZHONG X, LAN WH, WANG LF, et al. Efficacy of robotic renal transplantation in perioperative period[J]. J Army Med Univ, 2022, 44(18): 1862-1866. DOI: 10.16016/j.2097-0927.202204035.
    [15] 范阳, 王瀚锋, 祖强, 等. 机器人肾移植术学习曲线分析[J]. 微创泌尿外科杂志, 2022, 11(3): 150-155. DOI: 10.19558/j.cnki.10-1020/r.2022.03.002.

    FAN Y, WANG HF, ZU Q, et al. Analysis of learning curve of robot-assisted kidney transplantation[J]. J Mini Invasive Urol, 2022, 11(3): 150-155. DOI: 10.19558/j.cnki.10-1020/r.2022.03.002.
    [16] 林涛. 机器人辅助手术系统在肾移植中的应用[J]. 器官移植, 2022, 13(1): 1-5. DOI: 10.3969/j.issn.1674-7445.2022.01.001.

    LIN T. Application of robot assisted surgical system in kidney transplantation[J]. Organ Transplant, 2022, 13(1): 1-5. DOI: 10.3969/j.issn.1674-7445.2022.01.001.
    [17] 刘光香, 庄君龙, 邓永明, 等. 机器人辅助腹腔镜亲属供肾肾移植取-植一体术初步经验[J]. 中华外科杂志, 2023, 61(1): 66-68. DOI: 10.3760/cma.j.cn112139-20220715-00314.

    LIU GX, ZHUANG JL, DENG YM, et al. Preliminary experience of robot assisted laparoscopic kidney transplantation for relatives[J]. Chin J Surg, 2023, 61(1): 66-68. DOI: 10.3760/cma.j.cn112139-20220715-00314.
    [18] 姜玲, 甘晓琴, 裴皓玉, 等. 机器人辅助腹腔镜亲属肾移植术4例手术配合[J]. 现代医药卫生, 2023, 39(2): 354-357. DOI: 10.3969/j.issn.1009-5519.2023.02.038.

    JIANG L, GAN XQ, PEI HY, et al. Surgical cooperation in 4 cases of robot assisted laparoscopic relative kidney transplantation[J]. J Mod Med Health, 2023, 39(2): 354-357. DOI: 10.3969/j.issn.1009-5519.2023.02.038.
    [19] 董隽. 机器人辅助肾移植术的临床实践和发展前景[J]. 中华泌尿外科杂志, 2022, 43(12): 881-883. DOI: 10.3760/cma.j.cn112330-20221227-00680.

    DONG J. Clinical practice and prospect of robotic-assisted kidney transplantation[J]. Chin J Urol, 2022, 43(12): 881-883. DOI: 10.3760/cma.j.cn112330-20221227-00680.
    [20] 赵鉴明, 陈欣, 范阳, 等. 机器人辅助腹腔镜多支动脉肾移植术[J]. 微创泌尿外科杂志, 2021, 10(1): 8-11. DOI: 10.19558/j.cnki.10-1020/r.2021.01.003.

    ZHAO JM, CHEN X, FAN Y, et al. Robotic-assisted kidney transplantation in graft with multiple vessels[J]. J Mini Invasive Urol, 2021, 10(1): 8-11. DOI: 10.19558/j.cnki.10-1020/r.2021.01.003.
    [21] O'CONNOR-CORDOVA MA, ORTEGA-MACIAS AG, SANCEN-HERRERA JP, et al. Living donor robotic-assisted kidney transplant compared to traditional living donor open kidney transplant. Where do we stand now? a systematic review and meta-analysis[J]. Transplant Rev (Orlando), 2023, 37(4): 100789. DOI: 10.1016/j.trre.2023.100789.
    [22] HERRERA S, CARBONELL I, COFAN F, et al. Impact of robotic-assisted kidney transplantation on post-transplant infections: a case-control study[J]. World J Urol, 2023, 41(10): 2847-2853. DOI: 10.1007/s00345-023-04484-y.
    [23] EKŞI M, ŞAHIN S, EVREN İ, et al. Can robot-assisted kidney transplantation provide higher quality of life than open kidney transplantation during the early postoperative period?[J]. Int J Clin Pract, 2021, 75(8): e14288. DOI: 10.1111/ijcp.14288.
    [24] CAMPI R, PECORARO A, LI MARZI V, et al. Robotic versus open kidney transplantation from deceased donors: a prospective observational study[J]. Eur Urol Open Sci, 2022, 39: 36-46. DOI: 10.1016/j.euros.2022.03.007.
    [25] SPAGGIARI M, PETROCHENKOV E, GRUESSNER A, et al. Robotic kidney transplantation from deceased donors: a single-center experience[J]. Am J Transplant, 2023, 23(5): 642-648. DOI: 10.1016/j.ajt.2023.02.016.
    [26] KIM JM, KWON HE, KO Y, et al. Robot-assisted kidney transplantation in a morbidly obese patient with incisional hernia reconstruction and abdominoplasty: a case report[J]. Korean J Transplant, 2023, 37(3): 210-215. DOI: 10.4285/kjt.23.0021.
    [27] PRUDHOMME T, BEAUVAL JB, LESOURD M, et al. Robotic-assisted kidney transplantation in obese recipients compared to non-obese recipients: the European experience[J]. World J Urol, 2021, 39(4): 1287-1298. DOI: 10.1007/s00345-020-03309-6.
    [28] OBERHOLZER J, GIULIANOTTI P, DANIELSON KK, et al. Minimally invasive robotic kidney transplantation for obese patients previously denied access to transplantation[J]. Am J Transplant, 2013, 13(3): 721-728. DOI: 10.1111/ajt.12078.
    [29] TZVETANOV IG, SPAGGIARI M, TULLA KA, et al. Robotic kidney transplantation in the obese patient: 10-year experience from a single center[J]. Am J Transplant, 2020, 20(2): 430-440. DOI: 10.1111/ajt.15626.
    [30] LEE SD, RAWASHDEH B, MCCRACKEN EKE, et al. Robot-assisted kidney transplantation is a safe alternative approach for morbidly obese patients with end-stage renal disease[J]. Int J Med Robot, 2021, 17(5): e2293. DOI: 10.1002/rcs.2293.
    [31] DI COCCO P, BENCINI G, SPAGGIARI M, et al. Obesity and kidney transplantation-how to evaluate, what to do, and outcomes[J]. Transplantation, 2023, 107(9): 1903-1909. DOI: 10.1097/TP.0000000000004564.
    [32] SPAGGIARI M, DI COCCO P, TULLA K, et al. Simultaneous robotic kidney transplantation and bariatric surgery for morbidly obese patients with end-stage renal failure[J]. Am J Transplant, 2021, 21(4): 1525-1534. DOI: 10.1111/ajt.16322.
    [33] CHEN Y, DABBAS W, GANGEMI A, et al. Obesity management and chronic kidney disease[J]. Semin Nephrol, 2021, 41(4): 392-402. DOI: 10.1016/j.semnephrol.2021.06.010.
    [34] ROFAIEL G, MOLNAR MZ, BAKER N, et al. Robotic-assisted kidney transplantation with simultaneous bilateral nephrectomies is an efficient, feasible, and safe way to manage patients with renal failure secondary to adult polycystic kidney disease[J]. Transplant Direct, 2021, 7(9): e740. DOI: 10.1097/TXD.00000000000 01195.
    [35] SPAGGIARI M, ALMARIO J, AGUILUZ G, et al. Simultaneous robotic-assisted bilateral native nephrectomy and kidney transplantation for autosomal dominant polycystic kidney disease in recipients with high body mass index: report of 2 cases[J]. Transplant Proc, 2022, 54(7): 1781-1785. DOI: 10.1016/j.transproceed.2022.03.061.
    [36] TERRITO A, DIANA P, GAYA JM, et al. Robot-assisted kidney transplantation: state of art[J]. Arch Esp Urol, 2021, 74(10): 970-978.
    [37] PIANA A, GALLIOLI A, AMPARORE D, et al. Three-dimensional augmented reality-guided robotic-assisted kidney transplantation: breaking the limit of atheromatic plaques[J]. Eur Urol, 2022, 82(4): 419-426. DOI: 10.1016/j.eururo.2022.07.003.
    [38] AHLAWAT R. Robotic kidney transplantation under regional hypothermia[J]. J Endourol, 2022, 36(S2): S18-S24. DOI: 10.1089/end.2022.0362.
    [39] FAN Y, ZHAO J, ZU Q, et al. Robot-assisted kidney transplantation: initial experience with a modified hypothermia technique[J]. Urol Int, 2022, 106(5): 504-511. DOI: 10.1159/000521959.
    [40] TERRITO A, PIANA A, FONTANA M, et al. Step-by-step development of a cold ischemia device for open and robotic-assisted renal transplantation[J]. Eur Urol, 2021, 80(6): 738-745. DOI: 10.1016/j.eururo.2021.05.026.
    [41] PECORARO A, ANDRAS I, BOISSIER R, et al. The learning curve for open and minimally-invasive kidney transplantation: a systematic review[J]. Minerva Urol Nephrol, 2022, 74(6): 669-679. DOI: 10.23736/S2724-6051.22.04909-6.
    [42] BANSAL D, CHATURVEDI S, MAHESHWARI R, et al. Establishing a robot-assisted kidney transplant program: independent evaluation of the learning curve and surgical nuances[J]. J Endourol, 2021, 35(11): 1650-1658. DOI: 10.1089/end.2020.0923.
    [43] 张浩涵, 宋涂润, 马铭, 等. 机器人辅助活体肾移植的早期经验[J]. 中华器官移植杂志, 2022, 43(6): 334-339. DOI: 10.3760/cma.j.cn421203-20220305-00035.

    ZHANG HH, SONG TR, MANG M, et al. Early experience of robot assisted living donor kidney transplantation[J]. Chin J Organ Transplant, 2022, 43(6): 334-339. DOI: 10.3760/cma.j.cn421203-20220305- 00035.
    [44] CAMPI R, PECORARO A, VIGNOLINI G, et al. The first entirely 3D-printed training model for robot-assisted kidney transplantation: the RAKT box[J]. Eur Urol Open Sci, 2023, 53: 98-105. DOI: 10.1016/j.euros.2023.05.012.
    [45] KIM HJ, JEONG W, LEE J, et al. Successful robotic kidney transplantation for surgeons with no experience in minimally invasive surgery: a single institution experience[J]. Int J Surg, 2023,DOI: 10.1097/JS9.0000000000000977[Epub ahead of print
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  • 收稿日期:  2023-12-21
  • 网络出版日期:  2024-03-07

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