Robot-assisted third kidney transplantation in a patient with exhausted iliac fossae: A case report

Third kidney transplantation is rare and technically challenging because of exhausted iliac fossae, dense adhesions, and increased vascular risks. Robot-assisted kidney transplantation (RAKT) has emerged as a minimally invasive alternative, although its role in complex retransplantation remains uncertain. We report a 41-year-old man with two failed deceased-donor kidney transplants who underwent robot-assisted third kidney transplantation using the da Vinci Xi system. Vascular anastomoses were performed under continuous intra-abdominal hypothermic perfusion, and uretero-ureterostomy was selected because severe pelvic adhesions precluded bladder reconstruction. Immediate graft function was achieved, with serum creatinine decreasing to 62 μmol/L on postoperative day 2 and remaining stable thereafter. This case demonstrates that robot-assisted third kidney transplantation is feasible in carefully selected patients and suggests that robotic techniques may expand surgical options for complex kidney retransplantation.