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  • Review Article
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Robotic kidney transplantation

Nature Reviews Urology volume 21, pages 521–533 (2024)Cite this article

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Abstract

Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis. The surgical approach to kidney transplantation has been somewhat stagnant in the past 50 years, with the open approach being the only available option. In this scenario, evidence of reduced surgery-related morbidity after the introduction of robotics into several surgical fields has induced surgeons to consider robot-assisted kidney transplantation (RAKT) as an alternative approach to these fragile and immunocompromised patients. Since 2014, when the RAKT technique was standardized thanks to the pioneering collaboration between the Vattikuti Urology Institute and the Medanta hospital (Vattikuti Urology Institute-Medanta), several centres worldwide implemented RAKT programmes, providing interesting results regarding the safety and feasibility of this procedure. However, RAKT is still considered an alternative procedure to be offered mainly in the living donor setting, owing to various possible drawbacks such as prolonged rewarming time, demanding learning curve, and difficulties in carrying out this procedure in challenging scenarios (such as patients with obesity, severe atherosclerosis of the iliac vessels, deceased donor setting, or paediatric recipients). Nevertheless, the refinement of robotic platforms through the implementation of novel technologies as well as the encouraging results from multicentre collaborations under the umbrella of the European Association of Urology Robotic Urology Section are currently expanding the boundaries of RAKT, making this surgical procedure a real alternative to the open approach.

Key points

  • Kidney transplantation is the best treatment option for patients with end-stage renal disease owing to improved survival and quality of life compared with dialysis.

  • Robot-assisted kidney transplantation (RAKT) is emerging as an alternative minimally invasive approach to patients with end-stage renal disease.

  • RAKT has been implemented in several clinical scenarios, such as living and deceased donors, patients with obesity, paediatric recipients, and graft with multiple vessels.

  • Remaining barriers to the widespread adoption of this technique include a demanding learning curve, possible higher costs than the open approach, a shortage of trained surgeons and a lack of robotic platforms in kidney transplantation centres.

  • The introduction of 3D models and virtual reality simulation could enhance RAKT programmes worldwide.

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Fig. 1: Trocar placement for robot-assisted kidney transplantation and surgical access through a Gibson incision for open kidney transplantation.
Fig. 2: Main surgical steps of robot-assisted kidney transplantation.
Fig. 3: Decision-making process for the selection of RAKT candidates from deceased donors.

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Author notes

  1. These authors contributed equally: Giuseppe Basile, Alessio Pecoraro.

Authors and Affiliations

  1. Department of Urology, Fundació Puigvert, Autonomous University of Barcelona, Barcelona, Spain

    Giuseppe Basile, Alessio Pecoraro, Andrea Gallioli, Angelo Territo, Camille Berquin, Jorge Robalino, Alejandra Bravo, Jorge Huguet, Óscar Rodriguez-Faba, Pavel Gavrilov, Josep Maria Gaya, Joan Palou & Alberto Breda

  2. Department of Urology, IRCCS San Raffaele Hospital, Milan, Italy

    Giuseppe Basile

  3. Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence, Italy

    Alessio Pecoraro

  4. Department of Urology, University Hospital Ghent, Belgium, ERN eUROGEN accredited centre, Ghent, Belgium

    Camille Berquin

  5. Department of Nephrology, Fundaciò Puigvert, Autonoma University of Barcelona, Barcelona, Spain

    Carmen Facundo & Lluis Guirado

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Contributions

A. Bravo, G.B., A.P., A.G., J.R. and A. Breda, researched data for the article. A. Bravo, G.B., A.P., A.G., A.T., C.B., J.H., O.R.F., P.G., C.F., L.G., J.M.G. and J.P. contributed substantially to discussion of the content. A. Bravo, G.B., A.P. and A.G. wrote the article. A. Bravo, G.B., A.P. and A.G. reviewed and/or edited the manuscript before submission.

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Correspondence to Alberto Breda.

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Nature Reviews Urology thanks Amit Sharma; Jeff Veale, who co-reviewed with Michael Chen; and Mani Menon, who co-reviewed with Akshay Sood, for their contribution to the peer review of this work.

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Basile, G., Pecoraro, A., Gallioli, A. et al. Robotic kidney transplantation. Nat Rev Urol 21, 521–533 (2024). https://doi.org/10.1038/s41585-024-00865-z

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