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

Introduction: 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 popula-tion. 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.Methods: A systematic review was performed according to preferred reporting items for sys-tematic reviews and meta-analyses. Medline, Embase, and Cochrane databases were searched to identify all studies reporting post-operative outcomes of RAKT versus OKT. Results: A total of 2,136 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 minutes in OKT population; 250 and 60 minutes in RAKT population. Post-operative complications rates were: 26.2% in OKT population and 17.8% in RAKT popu-lation. 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 popu-lation.Conclusion: This systematic review showed that RAKT may be associated with a lower inci-dence 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.(c) 2023 AEU. Published by Elsevier Espana, S.L.U. All rights reserved.