经阴道机器人辅助肾移植1例报道及文献回顾

Early experience of robot assisted kidney transplantation

目的探索经阴道机器人辅助肾移植(robotic-assisted kidney transplantation,RAKT)的可行性及安全性。方法回顾性分析2021年6月28日四川大学华西医院1例经阴道RAKT手术的病例资料。通过持续肾表面冷却技术(continuous surface cooling technique,CSCT)术中使用冰生理盐水对移植肾进行冷却,使用达芬奇机器人辅助经会阴入路切开阴道后穹窿,置入移植物。术后对受者进行了3个月的随访。此外,以"机器人肾移植"和"阴道"为中文检索关键词,以"kidney transplantation"、"robot"和"vaginal"为英文检索关键词在万方数据库、中国知网、维普数据库、中国生物医学文献服务系统、PubMed、Embase和CENTRAL数据库检索发表时间为1990年6月至2022年6月的文献,详细总结已发表的所有病例。结果手术经过顺利完成,总时长为250 min,血管吻合时间为45 min,温缺血时间为63 min。受者术后恢复顺利,无阴道疼痛,无需术后镇痛;未发现腹腔感染。吻合时移植物表面温度维持于10~16℃。经文献检索,目前一共报道了12例经阴道的RAKT;除1例移植物位置不佳中转开放手术之外,所有病例均获得成功。文献报道的平均手术时间为(210±37)min,血管吻合时间为(41±8)min,温缺血时间为(50±10)min,无外科并发症发生。结论经阴道RAKT手术是安全可行的,应严格把握适应证并在术前做好评估。

Objective Exploring the surgical method and safety of robot assisted kidney transplantation(RAKT)with a kidney implanted through the vagina,currently there is no such surgery in China.Method Retrospective analysis of the data of a 44-year-old postpartum woman with stage 5 chronic kidney disease admitted to the kidney transplantation ward of West China Hospital,Sichuan University on June 28,2021.RAKT with a kidney inserted through the vagina was performed on the recipient.The transplanted kidney was cooled using continuous surface cooling technology(CSCT)using ice physiological saline.The recipient was followed up for 3 months after surgery.In addition,we searched the Wanfang database,China National Knowledge Infrastructure,VIP database,China Biomedical Literature Service System,PubMed,Embase,and Central databases.The Chinese search keywords were"robot kidney transplantation"and"vagina",while the English search keywords were"kidney transplantation"and"robot"and"vacuum".The literature was published from June 1990 to June 2022,and a detailed summary of all published cases was provided.Result a perineal approach was used to open the posterior fornix of the vagina and the graft was successfully implanted.The surgery was successfully completed,with a total duration of 250 minutes,vascular anastomosis time of 45 minutes,and warm ischemia time of 63 minutes.The recipient recovered smoothly without vaginal pain and postoperative pain relief;There was also no abdominal infection.Using CSCT,the surface temperature of the graft was maintained at 10~16℃during anastomosis.After literature review,a total of 12 cases of renal RAKT implantation through vagina have been reported.All cases were successful,except for one case where the graft was poorly positioned and converted to open surgery.The average surgical time reported in the literature is(210±37)minutes,vascular anastomosis time is(41±8)minutes,and warm ischemia time is(50±10)minutes.There were no surgical complications.Conclusion Transvaginal insertion of RAKT into the kidney is safe and feasible,but special types of recipients should be selected for this surgical method and evaluated before surgery.