Robotic kidney transplantation: current status and future perspectives

INTRODUCTION: For the treatment of patients with end-stage renal disease, kidney transplantation is preferred to renal replacement modalities such as hemodialysis and peritoneal dialysis. Although open surgery remains the gold standard, minimally invasive approaches have recently been applied in transplant kidney surgery. Despite growing enthusiasm and potential benefits of robotic kidney transplant, many aspects of this novel technique remain controversial. Aim of this study was to analyze the current status and future developments in robotic-assisted surgery for kidney transplantation. EVIDENCE ACQUISITION: A systematic PubMed search for peer-reviewed studies was performed using keywords such as "Minimally invasive surgery" or "Robotic" or "Robot assisted" AND "Kidney transplantation". Eligible articles were reviewed according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) criteria. EVIDENCE SYNTHESIS: Eleven studies evaluated reported the feasibility, safety, and reproducibility of robotic kidney transplantation using either a transperitoneal or an extraperitoneal approach. The graft kidney is usually introduced via a periumbilical or Gibson incision. The functional outcomes of the robotic approach are equivalent to those of open kidney transplantation in terms of mean serum creatinine at 6 month and delayed graft function. The benefits of robotic kidney transplantation include easier vascular anastomosis, better cosmetic results, and a lower complication rate, including in the obese population. Many concerns remain over the potential impairment of graft function due to pneumoperitoneum and warm ischemia and the technical difficulties related to the vascular anastomosis. Refinement of the robotic tactile feedback and development of a cold ischemia device may lead to further improvement in this novel technique. CONCLUSIONS: Robotic surgery allows kidney transplantation to be performed under optimal operative conditions, reducing complications while maintaining the functional results achieved by the open approach. The evolution of this technique is in progress.