Current status of robotic kidney transplant and its future.

Abstract

OBJECTIVES: Open kidney transplantation (OKT) represents the standard approach in patients with end-stage renal disease, but recently robotic-assisted kidney transplantation (RAKT) has also become an accepted approach. METHODS: We conducted a systematic review using the PubMed/Medline and Embase databases and the keywords "Robotic kidney transplantation" and "Robotic-assisted kidney transplantation". RESULTS: Past studies of RAKT have tended to suffer from patient selection bias, but, following completion of the learning curves in specialized centers, the indications for RAKT have recently been expanded to include more complex cases. The technique has evolved over the years, and currently both intraperitoneal and extraperitoneal approaches are accepted; however, it hasbeen suggested that the intraperitoneal technique offers advantages in obese patients. The Vattikuti-Medanta technique of RAKT with regional hypothermia, in which the graft is surrounded by a gauze jacket filled with ice slush, is the most widely accepted technique for maintenance of the graft temperature at below 18-20°C during surgery. A number of perioperative variables have been described, including operative time (145-255 min), total ischemia time (73-96 min), rewarming time (40-73 min), blood loss (88-150 mL), high-grade complication rate (3.75%-12.5%), and hospital stay (6-14 days). The data regarding functional outcomes show that RAKT presents a similar profile to OKT in terms of functionality at short- and long-term follow-up. While RAKT has been proposed as a safe and effective alternative in obese patients, such patients should be included in a weight loss program or under go simultaneous bariatric surgery. CONCLUSION: Despite its limitations, RAKT seems to be an attractive, feasible, safe, and reproducible surgery. It offers surgical advantages and a lower complication rate, especially in obese patients, and delivers functional outcomes comparable to those achieved using OKT.