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Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group

(2018) EUROPEAN UROLOGY FOCUS. 4(2). p.175-184
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Abstract
Background: Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. Objective: To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. Design, setting, and participants: We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. Intervention: RAKT with regional hypothermia. Outcome measurements and statistical analysis: Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. Results and limitations: Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88 min, p = 0.004 and 50 vs 34 min, p = 0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra-or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. Conclusions: RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. Patient summary: In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.
Keywords
LIVE DONOR NEPHRECTOMY, RENAL-ARTERIES, ALLOGRAFTS, OUTCOMES, Complications, EAU, ERUS, Kidney transplantation, Multiple arteries, Multiple vessels, Renal function, Robotics, Robot-assisted kidney, transplantation

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MLA
Siena, Giampaolo, et al. “Robot-Assisted Kidney Transplantation with Regional Hypothermia Using Grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: Results from the European Association of Urology Robotic Urology Section Working Group.” EUROPEAN UROLOGY FOCUS, vol. 4, no. 2, 2018, pp. 175–84.
APA
Siena, G., Campi, R., Decaestecker, K., Tugcu, V., Sahin, S., Alcaraz, A., … Serni, S. (2018). Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group. EUROPEAN UROLOGY FOCUS, 4(2), 175–184.
Chicago author-date
Siena, Giampaolo, Riccardo Campi, Karel Decaestecker, Volkan Tugcu, Selcuk Sahin, Antonio Alcaraz, Mireia Musquera, et al. 2018. “Robot-Assisted Kidney Transplantation with Regional Hypothermia Using Grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: Results from the European Association of Urology Robotic Urology Section Working Group.” EUROPEAN UROLOGY FOCUS 4 (2): 175–84.
Chicago author-date (all authors)
Siena, Giampaolo, Riccardo Campi, Karel Decaestecker, Volkan Tugcu, Selcuk Sahin, Antonio Alcaraz, Mireia Musquera, Angelo Territo, Luis Gausa, Caren Randon, Michael Stockle, Martin Janssen, Paolo Fornara, Nasreldin Mohammed, Luis Guirado, Carme Facundo, Nicolas Doumerc, Graziano Vignolini, Alberto Breda, and Sergio Serni. 2018. “Robot-Assisted Kidney Transplantation with Regional Hypothermia Using Grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: Results from the European Association of Urology Robotic Urology Section Working Group.” EUROPEAN UROLOGY FOCUS 4 (2): 175–184.
Vancouver
1.
Siena G, Campi R, Decaestecker K, Tugcu V, Sahin S, Alcaraz A, et al. Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group. EUROPEAN UROLOGY FOCUS. 2018;4(2):175–84.
IEEE
[1]
G. Siena et al., “Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group,” EUROPEAN UROLOGY FOCUS, vol. 4, no. 2, pp. 175–184, 2018.
@article{8662563,
  abstract     = {Background: Kidney transplantation using grafts with multiple vessels (GMVs) is technically demanding and may be associated with increased risk of complications or suboptimal graft function. To date, no studies have reported on robot-assisted kidney transplantation (RAKT) using GMVs. Objective: To report our experience with RAKT using GMVs from living donors, focusing on technical feasibility and early postoperative outcomes. Design, setting, and participants: We reviewed the multi-institutional, prospectively collected European Association of Urology (EAU) Robotic Urology Section (ERUS)-RAKT database to select consecutive patients undergoing RAKT from living donors using GMVs between July 2015 and January 2018. Patients undergoing RAKT using grafts with single vessels (GSVs) served as controls. In case of GMVs, ex vivo vascular reconstruction techniques were performed during bench surgery according to the case-specific anatomy. Intervention: RAKT with regional hypothermia. Outcome measurements and statistical analysis: Intraoperative outcomes and early (30 d) postoperative complications and functional results were the main study endpoints. Multivariable logistic regression analysis evaluated potential predictors of suboptimal renal function at 1 mo. Results and limitations: Overall, 148 RAKTs were performed during the study period. Of these, 21/148 (14.2%) used GMVs; in all cases, single arterial and venous anastomoses could be performed after vascular reconstruction. Median anastomoses and rewarming times did not differ significantly between the GMV and GSV groups. Total and cold ischemia times were significantly higher in the GMV cohort (112 vs 88 min, p = 0.004 and 50 vs 34 min, p = 0.003, respectively). Overall complication rate and early functional outcomes were similar among the two groups. No major intra-or postoperative complications were recorded in the GMV cohort. At multivariable analysis, use of GMVs was not significantly associated with suboptimal renal function at 1 mo. Small sample size and short follow-up represent the main study limitations. Conclusions: RAKT using GMVs from living donors is technically feasible and achieved favorable perioperative and short-term functional outcomes. Larger studies with longer follow-up are needed to confirm our findings. Patient summary: In this study, we evaluated for the first time in literature the results of RAKT from living donors using kidneys with multiple arteries and veins. We found that, in experienced centers, RAKT using kidneys with multiple vessels is feasible and achieves optimal results in terms of postoperative kidney function with a low number of postoperative complications. (C) 2018 European Association of Urology. Published by Elsevier B.V. All rights reserved.},
  author       = {Siena, Giampaolo and Campi, Riccardo and Decaestecker, Karel and Tugcu, Volkan and Sahin, Selcuk and Alcaraz, Antonio and Musquera, Mireia and Territo, Angelo and Gausa, Luis and Randon, Caren and Stockle, Michael and Janssen, Martin and Fornara, Paolo and Mohammed, Nasreldin and Guirado, Luis and Facundo, Carme and Doumerc, Nicolas and Vignolini, Graziano and Breda, Alberto and Serni, Sergio},
  issn         = {2405-4569},
  journal      = {EUROPEAN UROLOGY FOCUS},
  keywords     = {LIVE DONOR NEPHRECTOMY,RENAL-ARTERIES,ALLOGRAFTS,OUTCOMES,Complications,EAU,ERUS,Kidney transplantation,Multiple arteries,Multiple vessels,Renal function,Robotics,Robot-assisted kidney,transplantation},
  language     = {eng},
  number       = {2},
  pages        = {175--184},
  title        = {Robot-assisted kidney transplantation with regional hypothermia using grafts with Multiple Vessels After Extracorporeal Vascular Reconstruction: results from the European Association of Urology Robotic Urology Section Working Group},
  url          = {http://dx.doi.org/10.1016/j.euf.2018.07.022},
  volume       = {4},
  year         = {2018},
}

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