Living Donor Robot-Assisted Kidney Transplantation: a New Standard of Care?

Robot-assisted kidney transplantation (RAKT) has the potential to combine the advantages of minimally invasive surgery with the best renal replacement treatment. Over the last decade, the results were encouraging, as surgical and functional outcomes seem optimal in living donation. Recent studies focused on the comparison with open kidney transplantation (OKT), special situations such as obese patients or multiple vessels grafts and optimization of the technique to increase its surgical indications.

Relative to OKT, RAKT has longer rewarming time and operative time, but lower intraoperative blood loss. Wound-related events and postoperative pain decrease with robotic technique. This has been also demonstrated in obese patients, where RAKT may be particularly beneficial. No significant difference was found in graft function, graft survival, and patient survival with RAKT and OKT in short- and mid-term follow-up. A multiple vessels graft should not be considered a contraindication to robotic surgery. Intracorporeal cooling systems for regional hypothermia have not been applied in RAKT yet. Future challenges will be the inclusion of patients with atheromatous iliac arteries and transplantation programs for deceased donors. A randomized-controlled trial is needed to definitively confirm the findings of retrospective and prospective cohort studies. The implementation of the procedure in more centers depends on broader indications, which might ultimately decrease procedure-related costs. To guarantee the applicability of RAKT from deceased donors, it is fundamental to optimize the graft cooling systems and to include recipients with atheromatous iliac arteries.