Single-port robotic-assisted kidney transplantation: early benchmarks from a systematic review

Single-port (SP) robotic-assisted kidney transplantation (SP-RAKT) is an emerging minimally invasive approach whose perioperative safety profile and early graft outcomes remain poorly characterized. We performed a systematic review to summarize available evidence on SP-RAKT using the da Vinci SP platform.

A protocol-registered systematic review (PROSPERO: CRD420251086071) was conducted per PRISMA guidelines. PubMed and Embase were searched through June 28, 2025. Adult studies reporting perioperative, postoperative, or graft outcomes following SP-RAKT were included. Quantitative synthesis was restricted to allotransplantation studies, with preclinical and autotransplantation studies described narratively; weighted means were calculated for continuous outcomes and proportions for categorical outcomes. Study quality was assessed using Joanna Briggs Institute (JBI) and MINORS criteria.

Seventeen studies (272 procedures, 2019-2025) met inclusion criteria, of which only one was a full-text peer-reviewed clinical study; the remainder comprised conference abstracts, video reports, a preprint, and two preclinical studies. Quantitative synthesis of the 253 allotransplantation procedures showed a mean recipient age of 51.39 years and BMI of 31.70 kg/m²; 66% received living donor grafts. Mean operative time was 287.45 min, estimated blood loss 60.87 mL, and vascular anastomosis time 53.33 min. Mean hospital stay was 2.38 days. No conversion to open surgery was reported. Delayed graft function occurred in 6% of patients, overall complication rate was 10%, and 90-day readmission rate was 24%. Mean serum creatinine improved from 2.37 mg/dL at discharge to 1.48 mg/dL at last follow-up. No graft losses were reported at 6 or 12 months in cohorts with available data. Mean postoperative pain score was 3.93 and opioid consumption 61.20 morphine milligram equivalents.

Early institutional experience suggests SP-RAKT is technically feasible in carefully selected patients at experienced centers, with minimal blood loss, short hospitalization, and early graft function consistent with established benchmarks. Operative times reflect an expected learning curve and improve with experience. The evidence base is derived primarily from small, single-center, predominantly non-peer-reviewed series with heterogeneous outcome reporting; these findings support feasibility but not comparative safety or superiority over open or multi-port approaches. Prospective, multicenter trials with standardized endpoints are needed to define the definitive role of SP-RAKT in transplant surgery.

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