Robotic Assisted Kidney Transplantation: Update from the ERUS series

OBJECTIVE To report the results of the robotic assisted kidney transplantation experience performed in 10 European centers members of the ERUS-RAKT group. MATERIALS & METHODS This is a multicenter prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intra operative outcomes, complication rate and functional results were collected and analyzed. RESULTS Between July 2015 and September 2019, 291 living donor RAKT were performed. Recipients were mostly male (189 (65%)), mean age 45.2 years (SD 13.35); mean BMI of 27.13 kg/m2 (SD 19.28), and preemptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used around 15.4%. Mean total surgical and re-warming time was 244 min (SD 70.5), 53.16 min (SD 15.27) respectively. Seventeen patients presented postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one for acute rejection. Two patients had arterial stenosis, three incision hernias, six ureteral stenosis and nine lymphocele. Neither surgical time nor rewarming time showed correlation with post-operative serum creatinine levels (p>0.05). Comparison of surgical data between the first 120 cases and the following 171 cases demonstrated a significantly shorter total surgical time in the second group (265 vs. 230 minutes, p = 0.005) CONCLUSIONS: This is the largest European multicenter study on RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centers with a wide experience in open kidney transplantation and robotic surgery.