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Delayed graft function was observed in 1.7% of patients, whereas high-grade complications were encountered in 7.4% in the early postoperative period and in 5.4% of patients in the late postoperative period. In case of RAKT grafts with multiple vessels, no differenece was observed in terms of complications rate when comparing with simple vessel grafts.<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">7</span></a> Also, similar complications rate and functional outcomes were observed at 1.2 years follow-up when comparing RAKT in obese and non-obese recipients, knowing that obesity poses significant challenges during open KT.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Taking these into consideration the robotic approach has the potential to become the gold standard for KT. However, until present few papers have shown a direct comparison between OKT and RAKT. A recent systematic review and meta-analysis of studies reporting outcomes after RAKT or OKT showed that RAKT is a safe alternative to open surgery, with similar functional outcomes, but less surgical complications and shorter length of hospital stay.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> Moreover, a prospective study comparing 24 OKT and 25 RAKT demonstrated similar postoperative systemic inflammatory response syndrome between the two approaches, highlighting the safety of the robotic approach.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">10</span></a> The study published recently by Ahlawat el al.,<a class="elsevierStyleCrossRef" href="#bib0055"><span class="elsevierStyleSup">11</span></a> comparing 126 RAKT and 378 OKT, provides the highest level of evidence for the similarity between living donor RAKT and OKT. Notably, the authors observed a lower risk for symptomatic lymphoceles in the RAKT group (0% vs. 7%), a lower rate of wound complications (0% vs. 4%), reduced postoperative pain and less need for opioid analgesics.</p><p id="par0020" class="elsevierStylePara elsevierViewall">However, there is currently no randomized-controlled trial (RCT) to compare OKT and RAKT. There are some clinical and technical limitations for the wide applicability of RAKT, that also hamper the development of a RCT. First of all, the majority of the centers perform RAKT only from living-donors. There are logistical difficulties when performing RAKT from deceased donors, due to the need of having a robotic platform and a trained team available at all times, even during the night and weekends. A preliminary study let by Vignolini et al. showed the feasibility of this approach with favorable early postoperative and functional outcomes, if proper planning and logistic coordination is performed.<a class="elsevierStyleCrossRef" href="#bib0060"><span class="elsevierStyleSup">12</span></a> Moreover, in order to preserve its function during vascular anastomosis, the graft has to be maintained at low temperature, commonly using ice slush. Continuous insertion of ice slush poses some challenges during RAKT and does not gurantee constant low temperature, with the possibility to compromise graft function. A recent paper<a class="elsevierStyleCrossRef" href="#bib0065"><span class="elsevierStyleSup">13</span></a> presented the development of a cold-ischemia device, able to ensure a constant low temperature of the graft during the rewarming time of RAKT in a safe and reproducible manner. Lastly, the lack of haptic feedback has been incriminated as challenging during RAKT, considering that patients undergoing KT (mostly from deceased donors) commonly have multiple atherosclerotic plaques. In this regard, 3D augmented reality can assist the positioning of the clamps and the arteriotomy.<a class="elsevierStyleCrossRef" href="#bib0070"><span class="elsevierStyleSup">14</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">These technological advances overcome the limitations of RAKT and enable the possibility of a direct comparison between OKT and RAKT, that could include the whole population without the need to make exceptions, leading to a definite conclusion regarding the difference between these two approaches. A large multicenter RCT with long-term follow-up to prove non-inferiority (or even superiority) of RAKT as compared to OKT is awaited.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:14 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Quality of life in patients with chronic kidney disease: focus on end-stage renal disease treated with hemodialysis" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "P.L. Kimmel" 1 => "S.S. 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Journal Information
Vol. 47. Issue 4.
Pages 193-194 (May 2023)
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Vol. 47. Issue 4.
Pages 193-194 (May 2023)
Editorial
Aims and limits to compare open vs. robotic assisted kidney transplantation
Objetivos y limitaciones al comparar el trasplante renal abierto frente al asistido por robot
I. Andrasa,b,
, A. Pecoraroc, A. Pianad, T. Prudhommee, R. Campif,g, V. Heviah, R. Boissieri, N. Crisana,b, A. Bredaj, A. Territoj, on behalf of EAU-YAU kidney transplantation working group
Corresponding author
a Urology Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
b Urology Department, Clinical Municipal Hospital, Cluj-Napoca, Romania
c Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
d Department of Urology, San Luigi Gonzaga Hospital, Univerity of Turin, Orbassano, Turin, Italy
e Department of Urology and Kidney Transplantation, Toulouse University Hospital, Toulouse, France
f Unit of Urological Robotic Surgery and Renal Transplantation, University of Florence, Careggi Hospital, Florence, Italy
g Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
h Hospital Universitario Ramón y Cajal, Alcala University, Instituto Ramón y Cajal de Investigación Sanitaria, Madrid, Spain
i Service de Chirurgie Urologique et de Transplantation Renale, CHU Conception, Aix-Marseille Universite, Marseille, France
j Departement of Urology, Fundacio Puigvert, Autonomous University of Barcelona, Barcelona, Spain
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