Living donor robotic-assisted kidney transplant compared to traditional living donor open kidney transplant. Where do we stand now? A systematic review and meta-analysis.

BACKGROUND: Renal transplant is the standard of care for patients with end-stage renal disease (ESRD). Robotic-assisted kidney transplant (RAKT) has emerged as a safe minimally invasive approach with a lower complication rate than open kidney transplant (OKT). Concerns regarding ischemia times and graft function are still a matter of debate. METHODS: Following PRISMA guidelines and PROSPERO registration CRD42023413774, a systematic review was performed in March 2023 on RAKT compared to OKT. Primary outcomes of interest were surgical times, ischemia times, blood loss, complication rates, and graft function. Data were analyzed using R version 4.2.2. RESULTS: A total of nine studies comparing living donor RAKT to living donor OKT were included, totaling 1477 patients, out of which 508 underwent RAKT and 969 OKT. RAKT cases were highly selected as depicted in the manuscript. Cumulative analysis showed significantly longer total ischemic time (MD = 16.51; 95% CI = [9.86-23.16]) and rewarming ischemia time (MD = 11.24; 95% CI = [-0.46-22.01]) in RAKT group. No differences were found in total procedure time and time to complete anastomoses. Blood loss and transfusion rate were lower in RAKT group (MD = -53.68; 95% CI = [-89.78; -17.58]) and (RR = 0.29; 95% CI = [0.14; 0.57]), respectively. The meta-analysis revealed a lower rate of surgical site infection (SSI) (RR = 0.31; 95% CI = [0.19-0.52]) and symptomatic lymphocele (RR = 0.16; 95% CI = [0.06-0.43]) in RAKT. No difference in ileus rate was found. Pain scores were significantly lower in the RAKT group (MD = -1.14; 95% CI = [-1.59 - -0.69]; p ≤0.01). No difference in length of stay and hospital readmission were evidenced. Delayed graft function (DGF) and acute rejection rates were not different between interventions groups (RR =1.23; 95% CI = [0.40-3.74]) and (RR =0.96; 95% CI = [0.55-1.70]), respectively. No difference between groups in early graft outcomes are evident. CONCLUSIONS: Our analysis suggests that RAKT is a minimally invasive, safe, and feasible procedure. It is associated with a lower complication rate and similar intraoperative, perioperative, and postoperative outcomes. Further quality studies are needed to confirm these findings.

Laparoscopic Roux-en-Y gastric bypass in a patient with situs inversus totalis: case report.

The purpose of this report is to present the case of a patient with situs inversus totalis (SIT) who underwent laparoscopic gastric bypass and review of the literature. Situs inversus is a rare congenital abnormality that occurs in ~0.01% of the population and is characterized by transposition of the abdominal viscera1. When associated with dextrocardia, it is known as SIT. Electrocardiography reveals a reversal of the electrical waves of the heart and is the diagnostic measure of choice. Roux-en-Y laparoscopic gastric bypass for morbid obesity is one of the most effective bariatric procedures currently considered as the gold standard in bariatric surgery. We present the case of a 19-year-old male with morbid obesity and diagnosis of SIT, who underwent a laparoscopic gastric bypass adjusting the technique to the anatomical changes typical of this variant. It can be concluded, based on the previously compared cases and what was reported in ours, that in patients who have an indication to perform bariatric surgery and present SIT, surgery is not contraindicated, obtaining favorable results.