medigraphic.com
ISSN 2594-1518 (Electronic)
ISSN 1405-0099 (Print)

2025, Number 3

<< Back Next >>

Cir Gen 2025; 47 (3)

Robot-assisted laparoscopic living donor nephrectomy: initial experience in Mexico

Jiménez CE, Faustino VH, Fuentes DM

Language: Spanish
References: 50
Page: 135-144
PDF size: 834.74 Kb.


ABSTRACT

Introduction: renal transplantation, initiated with the success of Joseph Murray in 1954, represents a medical milestone. This paper focuses on living donor nephrectomy, recognizing its altruistic nature and the risks assumed by the donor. It analyzes the evolution of techniques, from open lumbotomy to laparoscopic and robotic approaches, highlighting the impact of minimally invasive surgery on donor recovery and graft quality. Objective: is to describe the technique and share the initial surgical experience in minimally invasive da Vinci robot-assisted related living donor nephrectomy for renal transplantation at a tertiary care center. Material and methods: A retrospective, descriptive study was conducted, analyzing the records of the first three cases who were candidates to receive da Vinci robot-assisted surgical management during July and August 2017. Statistical analysis was performed using the SPSS program. Results: In the initial experience, as part of the protocol for obtaining organs for transplantation with the intention of donation, three nephrectomies assisted with the da Vinci® Xi robot were performed. These procedures were carried out under the tutelage of a robotic surgery proctor experienced in this approach. The mean robot coupling (docking) time was 3.6 minutes. The average surgical time was 293 minutes. The mean blood loss was 100 ml. The hospital stay lasted 72 hours. There were no complications, no conversions, and no patient required reintervention. Conclusions: Currently, there is no evidence in the literature regarding robot-assisted approaches for obtaining organs for transplantation in Mexico. In the initial experience of donor nephrectomy for transplantation using the da Vinci robotic platform, good results were obtained, including prompt recovery, short hospital stay, and no complications. This experience serves as a basis for improving the living donor program.


REFERENCES

  1. Harrison JH, Merrill JP, Murray JE. Renal homotransplantation in identical twins. Surg Forum. 1956; 6: 432-436.

  2. Hume DM, Merrill JP, Miller BF, Thorn GW. Experiences with renal homotransplantation in the human: report of nine cases. J Clin Invest. 1955; 34: 327-382.

  3. Murray JE, Merrill JP, Harrison JH. Kidney transplantation between seven pairs of identical twins. Ann Surg. 1958; 148: 343-359.

  4. Ballesteros Sampol JJ. Indicaciones y morbimortalidad de la nefrectomía abierta: Análisis de 681 casos y revisión de la literatura. Arch Esp Urol. 2006; 59: 59-70.

  5. Mallafré Sala JM. Nefrectomía de donante vivo para trasplante renal. Arch Esp Urol. 2005; 58: 517-520.

  6. Oppenheimer F, Rossich E, Ricart MJ. Evolución del donante después de la nefrectomía: Morbi-mortalidad operatoria y postoperatoria e impacto a largo plazo de la nefrectomía. Arch Esp Urol. 2005; 58: 543-546.

  7. Álvarez R, Alcaraz A. Manual de cirugía del trasplante renal. Barcelona: Ed. Médica Panamericana; 1990. pp. 23-26.

  8. Netter FH. Atlas of human anatomy including student consult interactive ancillaries and guides. 6th ed. Philadelphia, Penn.: WB Saunders Co.; 2014. p. 315.

  9. Zorgdrager M, van Londen M, Westenberg LB, Nieuwenhuijs-Moeke GJ, Lange JFM, de Borst MH, et al. Chronic pain after hand-assisted laparoscopic donor nephrectomy. Br J Surg. 2019; 106: 711-719.

  10. Hernández-Vaquero D, Fernández-Fairen M, Torres-Perez A, Santamaría A. Minimally invasive surgery versus conventional surgery. A review of the scientific evidence. Rev Esp Cir Ortop Traumatol. 2012; 56: 444-458.

  11. Su LM, Ratner LE, Montgomery RA, Jarrett TW, Trock BJ, Sinkov V, et al. Laparoscopic live donor nephrectomy: trends in donor and recipient morbidity following 381 consecutive cases. Ann Surg. 2004; 240: 358-363.

  12. Challacombe B, Mamode N. Laparoscopic live donor nephrectomy. Nephrol Dial Transplant. 2004; 19: 2961-2964.

  13. Skrekas G, Papalois VE, Mitsis M, Hakim NS. Laparoscopic live donor nephrectomy: a step forward in kidney transplantation? JSLS. 2003; 7: 197-206.

  14. Zamora Torres AI, Díaz Barajas Y. Factores que inciden en la cultura de donación de órganos en Morelia, Michoacán: hacia una propuesta de política pública. Tla-melaua. 2018; 12: 98-119.

  15. Cantú-Quintanilla G, Medeiros-Domingo M, Gracida-Juárez C, Reyes-Acevedo R, Alberú-Goméz J, Barragán-Sánchez A. Trasplantes en América Latina y el Caribe: difusión del documento de Aguascalientes. PERS Bioét. 2014; 18: 226-237.

  16. Ruiz JL, Alemán FE, Young RM, Acosta HM, Castillo COA. Nefrectomía robótica del donante vivo para trasplante: primer caso en Latinoamérica. Rev Chil Cir. 2014; 66: 251-253.

  17. Luke PP, Aquil S, Alharbi B, Sharma H, Sener A. First Canadian experience with robotic laparoendoscopic single-site vs. standard laparoscopic living-donor nephrectomy: A prospective comparative study. Can Urol Assoc J. 2018; 12: E440-E446.

  18. Minnee RC, Idu MM. Laparoscopic donor nephrectomy. Neth J Med. 2010; 68: 199-206.

  19. Horgan S, Vanuno D, Sileri P, Cicalese L, Benedetti E. Robotic-assisted laparoscopic donor nephrectomy for kidney transplantation. Transplantation. 2002; 73: 1474-1479.

  20. Ratner LE, Ciseck LJ, Moore RG, Cigarroa FG, Kaufman HS, Kavoussi LR. Laparoscopic live donor nephrectomy. Transplantation. 1995; 60: 1047-1049.

  21. Windisch OL, Matter M, Pascual M, Sun P, Benamran D, Bühler L, et al. Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation. J Robot Surg. 2022; 16: 1471-1481.

  22. Escalante Cobo JL, del Río Gallegos F. Preservación de órganos. Med Intensiva. 2009; 33: 282-292.

  23. Gil-Villa SA, Campos-Salcedo JG, Zapata-Villalba MA, López-Silvestre JC, Estrada-Carrasco CE, Mendoza-Álvarez LA, et al. Prostatectomía radical laparoscópica asistida por robot: un año de experiencia en el Hospital Central Militar, reporte de los primeros 55 casos. Rev Mex Urol. 2016; 76: 87-93.

  24. Garibay González F, Navarrete Arellano M, Castillo Niño JC, García González FM, Sánchez Alejo JA. Cirugía urológica robótica. Primera serie pediátrica prospectiva en Latinoamérica. Rev Sanid Mil. 2018; 72: 281-288.

  25. Jiménez-Chavarría E, Gómez-Ramírez JO, Castellanos-Pérez JC, Martínez-Cuazitl A. Hepaticoyeyunostomía asistida por Robot vs la técnica abierta en un Hospital de tercer nivel. Rev Sanid Mil. 2022; 76: e01.

  26. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004; 240: 205-213.

  27. Law J, Rowe N, Archambault J, Nastis S, Sener A, Luke PP. First Canadian experience with robotic single-incision pyeloplasty: Comparison with multi-incision technique. Can Urol Assoc J. 2016; 10: 83-88.

  28. Congdon ED, Blumberg R, Henry W. Fasciae of fusion and elements of the fused enteric mesenteries in the human adult. Am J Anat. 1942; 70: 251-279.

  29. Murphy D, Challacombe B, Nedas T, Elhage O, Althoefer K, Seneviratne L, et al . Equipamiento y tecnología en robótica. Arch Esp Urol. 2007; 60: 349-355.

  30. Cruzat C, Olave E. Irrigación renal: multiplicidad de arterias. Int J Morphol. 2013; 31: 911-914.

  31. Rodríguez Corchero J, Pérez Espejo MP, Cruz Navarro N, Martínez Rodríguez J, Leal Arenas J, León Dueñas E, et al. "Back table" in descapsulated kidney for transplant. Actas Urol Esp. 2006; 30: 968.

  32. Khan A, Palit V, Myatt A, Cartledge JJ, Browning AJ, Joyce AD, et al. Assessment of Clavien-Dindo classification in patients >75 years undergoing nephrectomy/nephroureterectomy. Urol Ann. 2013; 5: 18-22.

  33. Clavien PA, Sanabria JR, Strasberg SM. Proposed classification of complications of surgery with examples of utility in cholecystectomy. Surgery. 1992; 111: 518-526.

  34. Valero R, Ko YH, Chauhan S, Schatloff O, Sivaraman A, Coelho RF, et al. Cirugía robótica: Historia e impacto en la enseñanza. Actas Urol Esp. 2011; 35: 540-545.

  35. Arroyo C, Gabilondo F, Gabilondo B. El estudio del donador vivo para trasplante renal. Rev Invest Clín. 2005; 57: 195-205.

  36. Stiegler P, Schemmer P. Robot-assisted transplant surgery - vision or reality? A comprehensive review. Visc Med. 2018; 34: 24-30.

  37. Horgan S, Galvani C, Gorodner MV, Jacobsen GR, Moser F, Manzelli A, et al. Effect of robotic assistance on the "learning curve" for laparoscopic hand-assisted donor nephrectomy. Surg Endosc. 2007; 21: 1512-1517.

  38. Álvarez-Maestro M, Ponce Díaz-Reixa J. Editorial: Trasplante renal. Arch Esp Urol. 2021; 74: 907-909.

  39. Argüero-Sánchez R, Sánchez-Ramírez O, Olivares-Durán EM. Donación cadavérica y trasplantes de órganos en México. Análisis de 12 años y siete propuestas estratégicas. Cir Cir. 2020; 88: 254-262.

  40. Centro Nacional de Trasplantes (México). Reporte anual 2023 de donación y trasplantes en México [Internet]. Ciudad de México: CENATRA; 2023. Disponible en: https://www.gob.mx/cms/uploads/attachment/file/289636/Presentacion_anual_2017.pdf

  41. Ballantyne GH, Moll F. The da Vinci telerobotic surgical system: the virtual operative field and telepresence surgery. Surg Clin North Am. 2003; 83: 1293-1304, vii.

  42. Martínez Ramos C. Robótica y cirugía laparoscópica. Cir Esp. 2006; 80: 189-194.

  43. Giacomoni A, Di Sandro S, Lauterio A, Concone G, Buscemi V, Rossetti O, et al. Robotic nephrectomy for living donation: surgical technique and literature systematic review. Am J Surg. 2016; 211: 1135-1142.

  44. Janki S, Klop KWJ, Hagen SM, Terkivatan T, Betjes MGH, Tran TCK, et al. Robotic surgery rapidly and successfully implemented in a high volume laparoscopic center on living kidney donation. Int J Med Robot. 2017; 13. doi: 10.1002/rcs.1743.

  45. Siena G, Vignolini G, Mari A, Li Marzi V, Caroassai S, Giancane S, et al. Full robot-assisted living donor nephrectomy and kidney transplantation in a twin dedicated operating room: initial experience from a high-volume robotic center. Surg Innov. 2019; 26: 449-455.

  46. Territo A, Gausa L, Alcaraz A, Musquera M, Doumerc N, Decaestecker K, et al. European experience of robot-assisted kidney transplantation: minimum of 1-year follow-up. BJU Int. 2018; 122: 255-262.

  47. Spiers HVM, Sharma V, Woywodt A, Sivaprakasam R, Augustine T. Robot-assisted kidney transplantation: an update. Clin Kidney J. 2021; 15: 635-643.

  48. Bamoulid J, Staeck O, Halleck F, Khadzhynov D, Paliege A, Brakemeier S, et al. Immunosuppression and results in renal transplantation. Eur Urol Suppl. 2016; 15: 415-429.

  49. Modi P, Pal B, Modi J, Kumar S, Sood A, Menon M. Robotic assisted kidney transplantation. Indian J Urol. 2014; 30: 287-292.

  50. Noyola VHF. Estado actual de la cirugía robótica en México. Rev Mex Cir Endoscop. 2017; 18: 5-6.




2020     |     www.medigraphic.com