Robot-Assisted Renal Transplant Surgery

Kidney transplantation (KT) is the standard treatment of patients with end-stage renal disease (ESRD), providing better outcomes in terms of quality of life and survival than dialysis. The open kidney transplantation (OKT) remains the gold standard for the treatment of ESRD. Several minimally invasive approaches have been proposed trying to reduce the morbidity and complication of open surgery as demonstrated in other fields of urologic surgery. Even when performed by an experienced laparoscopic surgeon, the mean operative time was significantly longer, with longer median rewarming time. Despite the advantages of minimally invasiveness translate in a faster recovery and better aesthetic, the laparoscopic procedure remains challenging, and the prolonged operative time could translate in a higher risk of acidosis due to the carbon dioxide reabsorption through the pneumoperitoneum and the impaired excretion due to ESRD state. Robot assisted surgery has overcame some limitations of laparoscopy through the high dexterity of robotic arms and showed similar operative time to open surgery, maintaining the advantages of minimally-invasiveness and the enhanced visualization of operative field. Few studies compared surgical and functional outcomes of robotic vs open approach, showing possible advantages of the robotic approach in selected cases, such as obese patients and multiple vessels graft. Additionally, many technological novelties have been introduced in robot assisted kidney transplantation in order to overcome its limitations.