Tuan Thanh Nguyen, Adnan El-Achkar, Ho Yee Tiong, Ryan W Dobbs, Jad Najdi, Narmina Khanmammadova Onder, Ngoc Sinh Tran, Huy Gia Vuong, Jacob Basilius, Xuan Thai Ngo, Van Dinh Le Quy, Trong Hieu Le, Tien-Dat Hoang, Khoa Quy, Minh Sam Thai, Muhammed A Hammad, Se Young Choi, Sohrab Naushad Ali, Mohammed Shahait, Hung Phan Huu, David I Lee
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Compared to OKT, the RAKT group had shorter incision length (SMD = -9.00, p < 0.001), fewer overall postoperative complications (RR = 0.52, p = 0.024), and reduced Clavien-Dindo III-IV complications (RR = 0.58, p = 0.013). However, RAKT was associated with significantly longer warm ischemia time (SMD = 0.66, p < 0.001), cold ischemia time (SMD = 0.96, p = 0.011), rewarming time (SMD = 3.08, p = 0.053), and total ischemia time (SMD = 1.73, p = 0.054). No significant differences were observed in intraoperative complications (RR = 1.09, p = 0.898), delayed graft function (RR = 0.90, p = 0.750), reoperation rates (RR = 0.63, p = 0.354), or recipient survival at 1 year (RR = 1.00, p = 0.233). Graft survival at 1 year was slightly higher in the RAKT group (RR = 1.01, p = 0.031), with adjusted 1-year graft survival showing a significant advantage (RR = 1.03, p = 0.001).</p><p><strong>Conclusions: </strong>Despite perioperative benefits, RAKT does not demonstrate superior long-term graft survival or patient outcomes compared to OKT. 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引用次数: 0
摘要
目的：比较机器人辅助肾移植（RAKT）和开放式肾移植（OKT）的围手术期和随访结果。方法：本系统评价和荟萃分析遵循PRISMA 2020指南，并在PROSPERO注册（CRD42022334583）。结果：7项研究符合纳入标准，共包括1263例肾移植病例（517例RAKT和919例OKT）。与OKT相比，RAKT组切口长度更短（SMD = -9.00, p < 0.001），术后总并发症更少（RR = 0.52, p = 0.024）， Clavien-Dindo III-IV并发症更少（RR = 0.58, p = 0.013）。然而，RAKT与较长的热缺血时间（SMD = 0.66, p < 0.001）、冷缺血时间（SMD = 0.96, p = 0.011）、再温时间（SMD = 3.08, p = 0.053）和总缺血时间（SMD = 1.73, p = 0.054）显著相关。术中并发症（RR = 1.09, p = 0.898）、移植物功能延迟（RR = 0.90, p = 0.750）、再手术率（RR = 0.63, p = 0.354）、1年生存率（RR = 1.00, p = 0.233）差异均无统计学意义。RAKT组1年移植物生存率略高（RR = 1.01, p = 0.031），调整后1年移植物生存率有显著优势（RR = 1.03, p = 0.001）。结论：尽管有围手术期的益处，但与OKT相比，RAKT并没有表现出更好的长期移植物存活或患者预后。它的采用仍然局限于专业中心，需要进一步的高质量研究来阐明其临床和经济影响。
Robotic-Assisted vs. Open Kidney Transplantation: A Systematic Review and Meta-Analysis of Propensity-Matched Studies.
Objectives: To compare the perioperative and follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT).
Methods: This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42022334583).
Results: Seven studies met the inclusion criteria, comprising a total of 1,263 kidney transplant cases (517 RAKT and 919 OKT). Compared to OKT, the RAKT group had shorter incision length (SMD = -9.00, p < 0.001), fewer overall postoperative complications (RR = 0.52, p = 0.024), and reduced Clavien-Dindo III-IV complications (RR = 0.58, p = 0.013). However, RAKT was associated with significantly longer warm ischemia time (SMD = 0.66, p < 0.001), cold ischemia time (SMD = 0.96, p = 0.011), rewarming time (SMD = 3.08, p = 0.053), and total ischemia time (SMD = 1.73, p = 0.054). No significant differences were observed in intraoperative complications (RR = 1.09, p = 0.898), delayed graft function (RR = 0.90, p = 0.750), reoperation rates (RR = 0.63, p = 0.354), or recipient survival at 1 year (RR = 1.00, p = 0.233). Graft survival at 1 year was slightly higher in the RAKT group (RR = 1.01, p = 0.031), with adjusted 1-year graft survival showing a significant advantage (RR = 1.03, p = 0.001).
Conclusions: Despite perioperative benefits, RAKT does not demonstrate superior long-term graft survival or patient outcomes compared to OKT. Its adoption remains limited to specialized centers, and further high-quality studies are needed to clarify its clinical and economic impact.
期刊介绍：
Urology is a monthly, peer–reviewed journal primarily for urologists, residents, interns, nephrologists, and other specialists interested in urology
The mission of Urology®, the "Gold Journal," is to provide practical, timely, and relevant clinical and basic science information to physicians and researchers practicing the art of urology worldwide. Urology® publishes original articles relating to adult and pediatric clinical urology as well as to clinical and basic science research. Topics in Urology® include pediatrics, surgical oncology, radiology, pathology, erectile dysfunction, infertility, incontinence, transplantation, endourology, andrology, female urology, reconstructive surgery, and medical oncology, as well as relevant basic science issues. Special features include rapid communication of important timely issues, surgeon''s workshops, interesting case reports, surgical techniques, clinical and basic science review articles, guest editorials, letters to the editor, book reviews, and historical articles in urology.
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