Open versus robotic-assisted kidney transplantation: A systematic review by the European Association of Urology (EAU) – Young Academic Urologists (YAU) Kidney Transplant Working Group

• Published in: Actas urológicas españolas (English ed.) 2023-10, Vol.47 (8), p.474-487
• Main Authors: Territo, A., Bajeot, A.S., Mesnard, B., Campi, R., Pecoraro, A., Hevia, V., Piana, A., Doumerc, N., Breda, A., Boissier, R., Prudhomme, T.
• Format: Article
• Language: English
• Subjects: Complicaciones postoperatorias; Delayed graft function; Open kidney transplantation; Post-operative complications; Retraso en la función del injerto; Robotic-assisted kidney transplantation; Trasplante renal abierto; Trasplante renal asistido por robot
• ISSN: 2173-5786; 2173-5786
• DOI: 10.1016/j.acuroe.2023.03.003

In the last 20 years, robotic assisted procedures were evaluated in the field of kidney transplantation to provide a mini-invasive approach for this particularly fragile population. As a relatively new issue, few studies compared open kidney transplantation (OKT) and robotic-assisted kidney transplantation (RAKT), mostly in small cohorts. To improve current knowledge, we wanted here to gather comparative data of OKT vs RAKT in a systematic review. A systematic review was performed according to preferred reporting items for systematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting post-operative outcomes of RAKT versus OKT. A total of 2136 patients in 13 studies were included. Median recipient age was 42.6 years (OKT: 43.5 years and RAKT: 40.3 years). Median preemptive kidney transplantation rate was 27.1 % (OKT: 23.3 % and RAKT: 33.2 %). Median total operative time and rewarming were respectively: 235 and 49 min in OKT population; 250 and 60 min in RAKT population. Post-operative complications rates were: 26.2 % in OKT population and 17.8 % in RAKT population. Delayed graft function rates were: 4.9 % in OKT population and 2.3 in RAKT population. Mid-term functional outcomes, patient and graft survival were similar in OKT and RAKT population. This systematic review showed that RAKT may be associated with a lower incidence of delayed graft function and post-operative surgical complications and similar mid-term functional outcomes, patient and graft survival, compared to OKT for end-stage renal disease patients. En los últimos 20 años se ha evaluado el uso de la robótica en el campo del trasplante renal como abordaje miniinvasivo a esta población especialmente vulnerable. Al tratarse de un campo relativamente novedoso, pocos estudios han comparado el trasplante renal abierto (TRA) y el trasplante renal asistido por robot (TRAR), la mayoría en cohortes pequeñas. Para ampliar los conocimientos actuales, hemos querido reunir en este documento datos comparativos de TRA frente a TRAR en una revisión sistemática. Se realizó una revisión sistemática de acuerdo con la declaración de Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Se realizaron búsquedas en las bases de datos Medline, Embase y Cochrane para identificar todos los estudios que informaran sobre los resultados postoperatorios del TRAR frente al TRA. Un total de 2.136 pacientes de 13 estudios fueron incluidos.