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Updated: Sep 20, 2025
Robot-Assisted Kidney Transplantation
Published on: July 19, 2021
Robot-assisted vs open kidney transplantation from deceased donors
Luca Afferi1,2,3, Angelo Territo2, Alessio Pecoraro4,5
1Department of Surgery, Autonomous University of Barcelona, Barcelona, Spain.
Objectives:
To test the hypothesis that the type of surgical approach, robot-assisted kidney transplantation (RAKT) vs open kidney transplantation (OKT), impacts intra-operative and postoperative surgical outcomes of patients receiving kidney transplantation from deceased donors.
Materials And Methods:
This was a multicentre retrospective cohort study including 676 patients who received RAKT or OKT in the period 2015 to 2023 in one of seven European academic centres. Patient heterogeneity at baseline was balanced using 2:1 nearest neighbour propensity-score matching. Intra- and postoperative complications were reported according to the Clavien-Dindo classification system. Kaplan-Meier estimates and the log-rank test were used to compare dialysis-free survival (DFS), graft survival (GS), reintervention-free survival (RFS) and overall survival (OS) according to the surgical approach used.
Results:
After propensity-score matching, two cohorts of 72 recipients (65%) in the OKT group and 37 (35%) in the RAKT group with similar baseline characteristics were obtained. The site of transplantation was the right iliac fossa in 59 (82%) and 28 patients (76%) undergoing OKT and RAKT, respectively. RAKT was associated with shorter rewarming time (53 vs 39 min), total vascular anastomosis time (55 vs 36 min), and arterial (25 vs 17 min) and venous (28 vs 18 min) anastomosis times (all P < 0.001), whereas OKT was associated with reduced surgical time (180 vs 200 min; P = 0.01). Intra-operative complications were more commonly reported in recipients undergoing OKT (8.3% vs 2.7%; P = 0.4). During follow-up, no differences in terms of postoperative complications, DFS, GS, RFS or OS were detected.
Conclusions:
This is the largest comparative study of RAKT vs OKT in the deceased donor setting. While it confirms the safety of RAKT from deceased donors, it underscores the superiority of RAKT in selected patients in terms of achieving vascular anastomosis and rewarming time in a shorter timeframe.
Insights
Robot-assisted kidney transplantation (RAKT) shows faster anastomosis and rewarming times compared to open kidney transplantation (OKT) in deceased donor recipients. Both approaches demonstrate similar long-term survival and complication rates.
Area of Science:
- Nephrology
- Surgical Innovation
- Transplantation Medicine
Background:
- Kidney transplantation is a vital treatment for end-stage renal disease.
- Surgical approach selection, robot-assisted kidney transplantation (RAKT) versus open kidney transplantation (OKT), may influence patient outcomes.
- Deceased donor kidney transplantation remains a critical area for surgical outcome optimization.
Purpose of the Study:
- To compare intra-operative and postoperative surgical outcomes between RAKT and OKT in deceased donor kidney recipients.
- To evaluate the impact of surgical approach on patient survival and complication rates.
- To determine if RAKT offers advantages over OKT in specific surgical metrics.
Main Methods:
- A multicentre retrospective cohort study involving 676 patients from 2015-2023 across seven European academic centres.
- Propensity-score matching was used to balance baseline patient characteristics between RAKT and OKT groups.
- Outcomes including intra- and postoperative complications (Clavien-Dindo), and survival endpoints (DFS, GS, RFS, OS) were analyzed using Kaplan-Meier estimates and log-rank tests.
Main Results:
- After matching, 72 OKT and 37 RAKT recipients were compared. RAKT demonstrated significantly shorter rewarming and vascular anastomosis times (arterial and venous).
- Open kidney transplantation (OKT) was associated with a shorter overall surgical time.
- Intra-operative complications were less frequent in the RAKT group (2.7% vs. 8.3% in OKT), though not statistically significant (P=0.4). No significant differences were observed in postoperative complications or survival rates (DFS, GS, RFS, OS).
Conclusions:
- Robot-assisted kidney transplantation (RAKT) is confirmed as a safe approach for deceased donor kidney transplantation.
- RAKT shows superiority in reducing rewarming and vascular anastomosis times, particularly beneficial for selected patients.
- While RAKT offers specific intra-operative advantages, long-term outcomes and complication rates are comparable to open kidney transplantation (OKT).
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management