Robot-assisted kidney transplantation in obese recipients: wound-risk reduction, graft safety, and access...

Obese kidney transplant recipients are at increased risk of surgical site infection, impaired wound healing, lymphocele, hematoma, and incisional hernia, and these wound-related risks have led some transplant programs to apply restrictive body mass index (BMI) thresholds. Robot-assisted kidney transplantation (RAKT) provides a minimally invasive approach by combining small-incision graft insertion with three-dimensional visualization, wristed instrumentation, and intracorporeal vascular and ureteral reconstruction. In obese recipients, this approach may reduce abdominal wall trauma while preserving precision during deep pelvic dissection and anastomosis. This narrative review summarizes the technical rationale, wound-related outcomes, perioperative results, graft safety, candidate selection, learning-curve considerations, and potential access implications of RAKT in obese recipients. Available evidence, mainly from retrospective cohorts, experienced-center series, and meta-analyses, suggests that RAKT may be associated with lower surgical site infection rates and acceptable short- to mid-term graft function in carefully selected patients. However, current evidence does not establish routine superiority over open kidney transplantation (OKT) or demonstrate improved waiting-list entry, listing, or transplantation rates. Important remaining barriers include rewarming-time control, regional hypothermia, vascular calcification, pneumoperitoneum management, cost-effectiveness, and limited long-term data. Future multicenter studies should integrate imaging-based risk stratification, standardized hypothermia protocols, structured training, and multidisciplinary weight-management pathways to define the role of RAKT in reducing wound-related morbidity and informing access-related decision-making in selected obese candidates.