Pediatric Challenges in Robot-Assisted Kidney Transplantation
Grammens, Julien (Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University)
Schechter, Michal Yaela (Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University)
Desender, Liesbeth (Ghent University Hospital. (Bèlgica))
Claeys, Tom (Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University)
Sinatti, Céline (Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University)
VandeWalle, Johan (Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University)
Vermassen, Frank (Ghent University Hospital. (Bèlgica))
Raes, Ann (Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University)
Vanpeteghem, Caroline (Universitair Ziekenhuis Gent)
Prytula, Agnieszka (Department of Pediatric Nephrology and Rheumatology, ERN ERKNet Accredited Centre, Ghent University Hospital, Ghent University)
Silay, Mesrur Selçuk (Division of Pediatric Urology, Department of Urology, Biruni University)
Breda, Alberto (Institut d'Investigació Biomèdica Sant Pau)
Decaestecker, Karel (Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University)
Spinoit, Anne-Françoise (Department of Urology, ERN eUROGEN Accredited Centre, Ghent University Hospital, Ghent University)
Universitat Autònoma de Barcelona

Fecha:	2021
Resumen:	Kidney transplantation is universally recognized as the gold standard treatment in patients with End-stage Kidney Disease (ESKD, or according to the latest nomenclature, CKD stage 5). Robot-assisted kidney transplantation (RAKT) is gradually becoming preferred technique in adults, even if applied in very few centra, with potentially improved clinical outcomes compared with open kidney transplantation. To date, only very few RAKT procedures in children have been described. Kidney transplant recipient patients, being immunocompromised, might be at increased risk for perioperative surgical complications, which creates additional challenges in management. Applying techniques of minimally invasive surgery may contribute to the improvement of clinical outcomes for the pediatric transplant patients population and help mitigate the morbidity of KT. However, many challenges remain ahead. Minimally invasive surgery has been consistently shown to produce improved clinical outcomes as compared to open surgery equivalents. Robot-assisted laparoscopic surgery (RALS) has been able to overcome many restrictions of classical laparoscopy, particularly in complex and demanding surgical procedures. Despite the presence of these improvements, many challenges lie ahead in the surgical and technical-material realms, in addition to anesthetic and economic considerations. RALS in children poses additional challenges to both the surgical and anesthesiology team, due to specific characteristics such as a small abdominal cavity and a reduced circulating blood volume. Cost-effectiveness, esthetic and functional wound outcomes, minimal age and weight to undergo RALS and effect of RAKT on graft function are discussed. Although data on RAKT in children is scarce, it is a safe and feasible procedure and results in excellent graft function. It should only be performed by a RAKT team experienced in both RALS and transplantation surgery, fully supported by a pediatric nephrology and anesthesiology team. Further research is necessary to better determine the value of the robotic approach as compared to the laparoscopic and open approach. Cost-effectiveness will remain an important subject of debate and is in need of further evaluation as well.
Derechos:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Lengua:	Anglès
Documento:	Article ; altres ; Versió publicada
Materia:	Pediatric kidney transplantation ; Kidney transplantation ; Pediatric robot-assisted kidney transplantation ; Robot-assisted kidney transplantation ; Robotics ; Robotic surgery ; Minimal-invasive surgery
Publicado en:	Frontiers in Surgery, Vol. 8 (march 2021) , ISSN 2296-875X

DOI: 10.3389/fsurg.2021.649418
PMID: 33842532

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