Comparison of outcomes after open versus robotic kidney transplantation: A systematic review and meta-analysis.

Introduction: This meta-analysis compares the clinical outcomes of robot-assisted kidney transplant (RAKT) to open kidney transplant (OKT). Methods: A systematic search of Scopus and MEDLINE databases was carried out using a combination of keywords to identify studies comparing RAKT to OKT. Baseline characteristics and preoperative and postoperative data were collected along with data on the short- and long-term outcomes. The study was registered in PROSPERO and Assessing the Methodological Quality of Systematic Reviews and Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines were followed. Results: A total of 16 studies were included with a total of 2555 patients, of which 677 underwent RAKT and 1878 underwent OKT. This meta-analysis shows a significant benefit of RAKT over OKT in terms of less intra-operative blood loss, smaller incision length, less postoperative pain scores at 24 and 48 hours, and a lower incidence of surgical site infections (SSIs), especially in obese patients. In addition, the incidence of postoperative lymphoceles was lower in the RAKT group compared to the OKT group, although not statistically significant. There was no difference between the two groups in terms of short-term graft functional outcomes and overall survival. The number of deceased donor recipients undergoing RAKT was very small. At the time of reporting this meta-analysis, no randomized controlled trials (RCTs) had been published. Conclusion: This meta-analysis showed that RAKT is a safe and feasible alternative to OKT, especially in obese individuals. Further trials are needed to confirm the safety, efficacy, and cost-effectiveness of RAKT.