Robot-assisted kidney transplantation: State of art.

OBJECTIVES

Nowadays, Robotic assistedkidney transplantation (RAKT) is considered a lessinvasive alternative to the Open Kidney Transplantation(OKT) with several advantages such as image magnification,3D vision and articulated instruments and with arelatively short learning curve for an experienced surgeon.RAKT has shown comparable outcomes with theOKT literature data in terms of surgical and functionalresults. RAKT may decrease the complication rate, meanhospital stay, postoperative pain, and also improve aestheticoutcomes. The aim of this study was to perform asystematic review of the literature on this novel approachof KT.

MATERIALS AND METHODS

A systematic review was performed in accordance with the Preferred ReportingItems for Systematic Reviews and Meta-Analyses (PRISMA)statement. The search was conducted using the databases PubMed/Medline, including as outcomes: (1) indications, (2) step-by-step technique for RAKT, (3) RAKT in special cases (4) surgical and functional outcomes,and (5) future perspectives in RAKT.

RESULTS

The indications for RAKT are expanding, sothat including obese recipients, graft with multiple vesselsand graft from deceased donor. To date, the two absolute contraindications to RAKT are patients unfitfor pneumoperitoneum and presenting advanced atheromatic plaques where vessel clamping could result challenging. As far as the outcomes, the surgical and functional results are in line with the OKT experience.Complication rate is low in RAKT, particularly in terms of arterial and venous thrombosis (1%), lymphocele (3%),ureteral stricture (2%), and wound infection (0.3%). Arobotic assisted kidney auto-transplantation (RAKAT) has been recently described, as novel approach in case of complex proximal benign ureteral stenosis. Despite great advances in this field, some limits still need to be approached such as the modality to main tain the graft to a constant low temperature ( <20 ºC) and to find the proper location of arteriotomy in advanced atheromatic disease without the tactile feedback.

CONCLUSION

The present review has confirmed that RAKT is as safe and feasible as OKT with comparable surgical and functional results. Complication rate is lower in RAKT than OKT and the indications are expanding quickly. Furthermore, new technologies are being introduced in order to improve the surgical performances and to expand more the indications for robotic surgery.However, a prospective randomized study in order to compare RAKT versus OKT is still required.