Objective:To summarize the preliminary experiences of utilizing complete peritoneal externalization for donation after cardiac death (DCD) robot-assisted kidney transplantation (RAKT) and observe the effect of RAKT versus open kidney transplantation (KT) under the same donor kidney during the same period.Methods:From February 2019 to July 2020, 40 patients scheduled for kidney transplantation were divided into two groups of robot ( n=20) and open surgery ( n=20). Donor for DCD had the same blood type. Preoperative data, intraoperative findings and postoperative outcomes were analyzed. Results:No significant inter-group difference existed in age, body mass index (BMI) or dialysis time. Both groups completed operations successfully. As compared with open group, operative duration, blocking time, venous anastomotic time and ureteral anastomosis time were longer in robot group. And the incidences of lymphatic fistula/cyst was higher in robot group than that in open group. Robot group was superior to open group in terms of hospitalization time, ventilation time, pain disappearance time and time to ambulate. No statistically significant inter-group difference existed in iliac vascular separation time, arterial anastomotic time, volume of blood loss and postoperative recovery of renal transplant function.Conclusions:RAKT is both safe and feasible at advanced surgical centers. Early evidence indicates that RAKT can accelerate the recovery of patients and achieve the same renal function recovery as open surgery. As surgeons become more proficient in RAKT technology, operative duration will be gradually shortened.

Objective To explore the learning curve of robotic-assisted kidney transplantation(RAKT).Methods The clinical data of 96 consecutive RAKT patients performed by the same surgical team were retrospectively analyzed.The arterial anastomosis time,venous anastomosis time,ureteral anastomosis time,hospital stay,and blood loss were selected as evaluation indicators.The learning curve of RAKT was analyzed using the cumulative sum(CUSUM),and the curve was divided into the learning improvement stage and the proficient mastery stage according to the learning curve.The learning curve was verified by comparing the general data and surgical data of patients in different learning stages,and the clinical efficacy of each stage was analyzed.Results The optimal fitting equation of the learning curve reached its peak at the 33rd case,which was the minimum number of surgeries required to master RAKT.There was no statistically significant difference in age,gender,dialysis type,previous abdominal surgery history,number of donor renal arteries,and preoperative serum creatinine between the learning improvement group and the proficient mastery group(all P>0.05).Compared with the learning improvement stage,the body mass index(BMI)was higher,and the number of right donor kidney was increased compared to the left donor kidney in the proficient mastery stage(both P<0.05).There were no significant differences in arterial anastomosis time,ureteral anastomosis time,postoperative serum creatinine,and complications between the two groups(all P>0.05).The iliac vessel dissection time,warm ischemia time,venous anastomosis time,blood loss,and hospital stay in the proficient mastery stage were superior to those in the learning improvement stage,with statistically significant differences(all P<0.05).Conclusions RAKT requires at least 33 cases to cross the learning curve.There is no difference in complications and recovery of transplant renal function between the learning improvement stage and the proficient mastery stage.

Objective To investigate the effect of pneumoperitoneum pressure during robotic-assisted kidney transplantation (RAKT) on the function of the transplant kidney. Methods The data of 243 kidney transplant recipients were retrospectively analyzed and divided into open kidney transplantation (OKT) group (n=105) and RAKT group (n=138). The RAKT group was further divided into 13 mmHg group (n=67) and 7 mmHg group (n=71) based on pneumoperitoneum pressure. The donor information, recipient's preoperative general data, intraoperative data, and postoperative recovery of the three groups were compared. In the RAKT group, the renal artery, segmental artery, interlobar artery, and venous flow velocity of the transplant kidney were measured using laparoscopic ultrasound. Results There was a statistically significant difference in donor types among the groups (P<0.05), while other donor information and recipient's preoperative general data showed no statistically significant differences (all P>0.05). There were no statistically significant differences in serum creatinine and complications at 30 days and 1 year postoperatively among the groups (all P>0.05). The OKT group and 7 mmHg group had more intraoperative urine output than the 13 mmHg group. Both RAKT groups had less intraoperative blood loss and shorter hospital stays than the OKT group, and longer operation times than the OKT group (all P<0.05). There were no statistically significant differences in operation time, intraoperative blood loss, and hospital stay between the two RAKT groups (all P>0.05). The vascular flow velocity of the transplant kidney decreased at 13 mmHg compared to 7 mmHg pneumoperitoneum pressure, but the differences were not statistically significant (all P>0.05). Conclusions Controllable pneumoperitoneum pressure has a limited impact on the vascular flow velocity of the transplanted kidney. RAKT is a safe and effective surgical method under appropriate pneumoperitoneum pressure, and choosing a lower pneumoperitoneum pressure is more conducive to the early recovery of renal function postoperatively.