Extraperitoneal Robot-Assisted Kidney Transplant: Initial Experience and Propensity-Matched Comparison with...

Area of Science:

• Urology
• Minimally Invasive Surgery
• Transplant Surgery

Background:

• Traditional robot-assisted kidney transplant (RAKT) uses a transperitoneal approach, posing risks like cardio-respiratory and bowel complications due to steep Trendelenburg positioning.
• An alternative extraperitoneal approach (EP-RAKT) aims to mitigate these risks.

Purpose of the Study:

• To evaluate the feasibility, technical aspects, and outcomes of the extraperitoneal approach for robot-assisted kidney transplant (EP-RAKT).
• To compare EP-RAKT with the traditional transperitoneal approach (TP-RAKT).

Main Methods:

• Prospective review of patients undergoing EP-RAKT (June 2023-May 2024).
• Propensity-matched comparison with patients who underwent TP-RAKT (1:2 ratio).
• Analysis of demographic, radiological, operative, and postoperative outcomes.

Main Results:

• EP-RAKT showed significantly shorter durations of postoperative ileus, reduced drain output, and lower pain scores compared to TP-RAKT.
• No differences in blood loss, ischemia time, anastomosis time, or graft function were observed between the groups.
• EP-RAKT demonstrated more consistent early postoperative tacrolimus levels, despite longer operative and port placement times.

Conclusions:

• Extraperitoneal robot-assisted kidney transplant (EP-RAKT) is a safe and feasible alternative to the transperitoneal approach (TP-RAKT).
• EP-RAKT offers reduced early postoperative complications and similar graft function.
• Increased operative time is a trade-off for the benefits of the extraperitoneal approach.