Abstract
Background: Nutcracker syndrome (NCS) is a compression of the left renal vein (LRV) at the level between superior mesenteric artery (SMA) and aorta, resulting in limited blood flow from kidney to vena cava. This leads to symptoms such as flank pain, hematuria, and renal dysfunction. Robotic assisted (RA) interventions have been recently applied for management of NCS. In this systematic review we aim to analyze effectiveness, advantages, and future implications of RA techniques in the management of NCS. Methods: Following the PRISMA guidelines, a systematic search was conducted among four medical databases: PubMed, Web of Science, Cochrane Reviews, and Embase. We have included peer-reviewed original articles, which have applied RA techniques in the management of NCS. We have extracted demographical information, patient symptoms, types of robotic systems used, surgical procedures performed, and outcomes such as complications, surgery time, blood loss, and post-operative hospital duration. Results: From 126 initially identified studies, 21 met the inclusion criteria. Most of the included studies reported interventions with the use of da Vinci robotic system (16/21). Surgical procedures included LRV transposition, renal auto-transplantation, and extravascular stent placement. While studies reported successful surgeries, some complications such as chyle leaks, hematomas, and graft occlusions were reported. Conclusions: RA surgery for NCS management has proven to be new promising method for treatment. Robots allow for enhanced precision, reduced postoperative pain, and faster recovery times. Although these benefits might be encouraging, literature is limited by case reports and lacks long-term follow-up data. Future trials should analyze effectiveness of robotic systems to conventional options of treatment.
Published Version
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