# Living-donor kidney transplantation: comparison of robotic-assisted versus conventional open technique in obese recipients

## TL;DR

This study compares robotic-assisted and conventional open kidney transplant techniques in obese patients, finding similar outcomes but shorter hospital stays with the robotic method.

## Contribution

The study provides evidence that robotic-assisted kidney transplantation is safe and effective for obese recipients, with potential benefits over conventional surgery.

## Key findings

- Median hospitalization was shorter for robotic-assisted (9 days) compared to conventional (12 days) transplants.
- Surgical reintervention rates were significantly lower in the robotic-assisted group.
- Early postoperative complications and graft survival were similar between the two techniques.

## Abstract

The objective was to compare the intraoperative, postoperative and functional outcomes of obese recipients undergoing robot-assisted living donor kidney transplantation (RAKT) compared to conventional open kidney transplantation (OKT).

A retrospective analysis of living donor’s kidney transplantation performed in a tertiary French academic center between January 2012 and January 2025 was performed. Only recipients who were obese (BMI ≥ 30 g/m2) at the time of transplantation were included.

A total of 86 patients were included in our study, including 46 patients in the RAKT group and 40 patients in the OKT group. The two groups were comparable except a higher rate of previous abdominal surgery in the OKT group (65% versus 28%; p = 0.001). Early postoperative complications and delayed graft function were similar between the 2 groups. One death occurred on postoperative day 15 in the OKT group due to cardiac arrest. Two open conversions occurred in the RAKT group: one due to active bleeding and one due to intraoperative venous thrombosis. Median length of hospitalization was significantly longer in the OKT group (12 versus 9 days, p = 0.001). The rate of surgical reintervention after POD 90 was significantly higher in the OKT group (37.5% versus 6.5%, p = 0.003). 1- and 3-patient and graft survival were comparable between the RAKT and OKT cohorts.

Our outcomes confirms the safety and efficacy of robotic approach for living donor kidney transplantation in obese recipients.