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World J Transplant. Jul 18, 2022; 12(7): 163-174
Published online Jul 18, 2022. doi: 10.5500/wjt.v12.i7.163
Robot-assisted kidney transplantation: Is it getting ready for prime time?
Vincenzo Li Marzi, Alessio Pecoraro, Maria Lucia Gallo, Leonardo Caroti, Adriano Peris, Graziano Vignolini, Sergio Serni, Riccardo Campi
Vincenzo Li Marzi, Alessio Pecoraro, Maria Lucia Gallo, Graziano Vignolini, Riccardo Campi, Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Florence 50134, Italy
Leonardo Caroti, Nephrology Unit, Careggi Hospital, Florence 50134, Italy
Adriano Peris, Intensive Care Unit and Regional ECMO Referral Centre, Careggi Hospital, Florence 50134, Italy
Sergio Serni, Department of Minimally Invasive and Robotic Urologic Surgery, University of Florence, Florence 50134, Italy
Sergio Serni, Riccardo Campi, Department of Experimental and Clinical Medicine, University of Florence, Florence 50134, Italy
Author contributions: Li Marzi V and Campi R conceptualized and designed the study; Gallo ML collected data; Pecoraro A and Campi R wrote the manuscript and made the figures and table; Serni S, Vignolini G, Li Marzi V, Peris A, and Caroti L revised the manuscript for important intellectual content.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vincenzo Li Marzi, MD, Surgeon, Department of Minimally Invasive and Robotic Urologic Surgery, Careggi University Hospital, University of Florence, Largo Brambilla 3, Florence 50134, Italy. limarzi2012@gmail.com
Received: December 23, 2021
Peer-review started: December 23, 2021
First decision: February 15, 2022
Revised: March 8, 2022
Accepted: June 16, 2022
Article in press: June 16, 2022
Published online: July 18, 2022
Abstract

Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint, KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery, especially due to its potential benefits for fragile and immunocompromised recipients. It was not until 2014 that the role of RAKT has found value thanks to the pioneering Vattikuti Urology Institute-Medanta collaboration that conceptualized and developed a new surgical technique for RAKT following the Idea, Development, Exploration, Assessment, Long-term follow-up recommendations for introducing surgical innovations into real-life practice. During the last years, mirroring the Vattikuti-Medanta technique, several centers developed RAKT program worldwide, providing strong evidence about the safety and the feasibility of this procedure. However, the majority of RAKT are still performed in the living donor setting, as an “eligible” procedure, while only a few centers have realized KT through a robotic approach in the challenging scenario of cadaver donation. In addition, despite the spread of minimally-invasive (predominantly robotic) surgery worldwide, many KTs are still performed in an open fashion. Regardless of the type of incision employed by surgeons, open KT may lead to non-negligible risks of wound complications, especially among obese patients. Particularly, the assessment for KT should consider not only the added surgical technical challenges but also the higher risk of postoperative complications. In this context, robotic surgery could offer several benefits, including providing a better exposure of the surgical field and better instrument maneuverability, as well as the possibility to integrate other technological nuances, such as the use of intraoperative fluorescence vascular imaging with indocyanine green to assess the ureteral vascularization before the uretero-vesical anastomosis. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.

Keywords: Deceased donors, Living donors, Kidney transplantation, Minimally invasive surgery, Robotics

Core Tip: Kidney transplantation (KT) is the treatment of choice for patients with end-stage renal disease, providing a better survival rate and quality of life compared to dialysis. Despite the progress in the medical management of KT patients, from a purely surgical standpoint KT has resisted innovations during the last 50 years. Recently, robot-assisted KT (RAKT) has been proposed as an alternative approach to open surgery especially thanks to its potential benefits for fragile and immunocompromised recipients. Therefore, our review aims to report the more significant experiences regarding RAKT, focusing on the results and future perspectives.