Robot-assisted versus open kidney transplantation: an umbrella review of systematic reviews and meta-analyses

Clinical Snapshot

Key Findings

• P Value: Not reported in abstract

• Effect Size: Blood loss: mean difference −16 to −55 mL favouring RAKT across included studies. RAKT also favoured for post-operative pain, incision length, SSI, and ureteral leak. OKT favoured for CIT, rewarming time, total ischemia time, operative time, and ileus rate. No significant difference in graft rejection, graft failure, all-cause mortality, or hospital readmission.

• Primary Outcome: Comparative perioperative and long-term outcomes of RAKT versus OKT across multiple domains

• Nnt Or Sensitivity: Not calculable from available data; no NNT, absolute risk reduction, or odds/risk ratios reported in the abstract

• Confidence Interval: Not reported in abstract

Clinical Application

RAKT requires specialised robotic surgical training, dedicated equipment (da Vinci surgical system), and institutional infrastructure. Operative times and ischemia times are longer with RAKT, which has implications for theatre scheduling and organ viability. The technique is not universally available and remains concentrated in tertiary referral centres globally. In Australia, robotic-assisted surgery is available at select major public and private hospitals, but RAKT remains in early adoption phase with very limited centres performing the procedure. The TGA has approved robotic surgical platforms for use in Australia, but there is no specific PBS item number for RAKT, and costs are substantially higher than OKT. RACGP and TSANZ (Transplantation Society of Australia and New Zealand) guidelines do not currently endorse RAKT as standard of care. Australian transplant programmes, predominantly based in major metropolitan centres (Sydney, Melbourne, Brisbane), would need to evaluate local volume, training capacity, and cost-effectiveness before adoption. The finding of equivalent graft and patient survival is reassuring but insufficient alone to justify the resource investment without higher-certainty evidence. Adult kidney transplant recipients, particularly those who may benefit from minimally invasive approaches (e.g., obese patients, those at elevated risk of wound complications). Evidence is most applicable to patients at high-volume robotic transplant centres with established programmes.

Abstract

Robot-assisted kidney transplantation (RAKT) has emerged as a minimally invasive alternative to open kidney transplantation (OKT). However, the comparative benefits and limitations of both approaches remain unclear. To compare the outcomes of RAKT and OKT through an umbrella review of published systematic reviews and meta-analyses. This umbrella review was written following PRISMA guidelines. Only meta-analysis and systematic review were included. Many outcomes were studied such as warm (WIT) and cold ischemia times (CIT), rewarming time, total ischemia time, blood loss, blood transfusion, delayed graft function, surgical site infections (SSI), hospital stay, graft rejection, graft failure, all-cause mortality, operation time, incision length, hospital readmission, vascular and ureteral anastomosis time, and other complications. We assessed methodological quality via the AMSTAR-2 tool. Consistency and strength of evidence were also evaluated. 6 studies were included: four meta-analyses and two systematic reviews. Studies were of low to moderate quality. Robotic kidney transplant surgery yields better outcomes in terms of blood loss (MDs ranging from - 16 to - 55 mL across studies), post-operative pain, incision length, SSI and ureteral leak. On the other hand, CIT, rewarming time, total ischemia time, operative time and ileus rate were favored in open surgery. Same rejection rates, graft failure, mortality and hospital readmission rate were found between both techniques. RAKT appears to improve several perioperative outcomes while maintaining comparable graft and patient survival outcomes to OKT. However, the available evidence remains limited by the low-to-moderate quality of existing reviews, highlighting the need for high-quality prospective studies.

References

1. 1.Madi, R., & Helou, E. (2026). Robot-assisted versus open kidney transplantation: an umbrella review of systematic reviews and meta-analyses. Journal of Robotic Surgery. https://doi.org/10.1007/s11701-025-02456-7