Initial experience with robotic-assisted kidney transplantation: A single-centre descriptive, retrospective study with technical modifications.

Abstract

<h4>Introduction</h4>Robot-assisted kidney transplantation (RAKT) has demonstrated non-inferiority to open kidney transplantation (OKT), with particular benefits for obese patients. We report our single-centre initial experience implementing RAKT with technical modifications.<h4>Patients and methods</h4>This retrospective descriptive study analysed consecutive living donor kidney transplants performed between September 2020 and March 2021. From 75 potential candidates, patients were selected for RAKT based on exclusion criteria, including obesity (body mass index [BMI] >35 kg/m²), severe atherosclerosis and previous complex abdominal surgery. Ten patients underwent RAKT and were matched 1:3 with OKT controls using propensity score matching based on age, sex, BMI and diabetes status. Technical modifications included polyglactin mesh wrapping for graft stabilisation and continuous cooling and a custom robotic arterial punch device. The primary surgeon completed 35 RAKT procedures at a high-volume centre before initiating this programme.<h4>Results</h4>Ten RAKT patients (90% male, mean age 41.5 ± 10.2 years, mean BMI 27.0 ± 3.2 kg/m²) were compared to 30 matched OKT controls. Mean operative time was 263 ± 29 min for RAKT versus 185 ± 22 min for OKT (P < 0.001). Warm ischaemia time averaged 52.2 ± 16.8 min for RAKT versus 3.2 ± 1.1 min for OKT (P < 0.001). All grafts functioned immediately except one delayed graft function in each group. Hospital stay averaged 8.0 ± 1.5 days for RAKT versus 7.2 ± 1.8 days for OKT (P = 0.21). At median follow-up of 60 months, graft survival was 100% in both groups. No incisional hernias occurred in RAKT patients versus 2 (6.7%) in OKT. Overall, 30-day complications were 10% for RAKT versus 20% for OKT (P = 0.66).<h4>Conclusions</h4>This small descriptive study demonstrates RAKT feasibility with technical modifications at an experienced centre. While no definitive conclusions can be drawn from this limited experience, our results align with larger studies supporting RAKT safety. The polyglactin mesh technique for continuous cooling and manipulation, along with the absence of incisional hernias, warrants further investigation in larger cohorts.