Robot-assisted kidney transplantation: Is it getting ready for prime time?

Area of Science:

• Urology
• Surgical Innovation
• Transplantation Surgery

Background:

• Kidney transplantation (KT) is the preferred treatment for end-stage renal disease, outperforming dialysis.
• Traditional open KT surgery has seen limited innovation over the past 50 years.
• Robot-assisted KT (RAKT) is emerging as a minimally invasive alternative, especially for vulnerable patients.

Purpose of the Study:

• To review significant experiences and outcomes of robot-assisted kidney transplantation.
• To highlight the safety, feasibility, and potential benefits of RAKT.
• To discuss future perspectives for robotic approaches in KT, including cadaveric donation.

Main Methods:

• Review of pioneering RAKT techniques and global center experiences.
• Analysis of outcomes comparing RAKT with traditional open KT.
• Focus on advancements like intraoperative fluorescence imaging for ureteral assessment.

Main Results:

• RAKT has demonstrated safety and feasibility, with several centers adopting the technique.
• Minimally invasive approaches, including RAKT, may reduce wound complications compared to open surgery.
• RAKT is predominantly performed with living donors, but cadaveric donation is an emerging challenge.

Conclusions:

• RAKT is a viable and safe procedure with potential advantages over open surgery.
• Robotic surgery offers enhanced visualization and maneuverability, crucial for complex KT procedures.
• Further development and adoption of RAKT, especially in cadaveric donation, are anticipated.