Progress made on robot-assisted kidney transplantation

By Scott Baltic

NEW YORK (Reuters Health) - When performed in selected patients by surgeons with specialized experience, robot-assisted kidney transplantation (RAKT) can result in “low complication rates, rapid recovery, and excellent graft function,” researchers in Europe conclude.

The surgeons were trained in an animal laboratory before performing RAKT in humans and were proctored during that training and their first four human RAKT procedures. Patients were selected for RAKT because of body size, lack of previous abdominal surgery, and other pertinent criteria.

Given that patients with end-stage renal disease are typically immunocompromised, the researchers hypothesized that such patients might benefit significantly from minimally invasive kidney transplantation. They call their study “the first and largest reported multicenter prospective study on RAKT.”

In this non-randomized investigation, they enrolled 120 nonconsecutive patients (62.5% male) at eight centers. The cohort had a median age of 43, a median BMI of 25.2, and a median dialysis duration of 365 days. Nearly all of the kidneys (98%) came from living donors. Minimum follow-up was one month.

Postoperative complications, occurring in no more than one per patient, included one case of wound infection, three cases of ileus, four cases of bleeding (3 required transfusion), one case of deep-vein thrombosis requiring anticoagulant drugs, one case of lymphocele requiring percutaneous drainage, three cases of transplantectomy due to massive arterial thrombosis, and five cases in which surgical exploration was performed for intraperitoneal hematoma.

Dr. Lloyd E. Ratner, director of renal and pancreatic transplantation at Columbia University Medical Center, New York, told Reuters Health in a phone interview that any new procedure should pass three tests: Is it technically feasible, is it safe, and does it bring better results? RAKT had been shown to be technically feasible, he noted, and the new study shows that its safety is comparable to that of open surgery.

“From an incremental standpoint, they’re making progress,” he said, but “I don’t think they’re there yet. . . . No one has reported yet that there’s an advantage to doing these procedures robotically.”

Dr. Ratner noted the lack of a control group in the current study and the paucity of information on how patients were selected for RAKT, although the authors acknowledged possible selection bias and other limitations of their study.

“The cost of the surgical robot is a big issue,” Ratner added, in part because surgical robots are at present a monopoly. “To an extent, it has been a device in search of an indication.”

The study’s corresponding author did not respond a request for comment.

SOURCE: http://bit.ly/2fmB3Rb

Eur Urol 2017.

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