Robot-Assisted versus Conventional Open Kidney Transplantation: A Meta-Analysis

Abstract

Background. Perioperative and follow-up outcomes for patients that received robot-assisted kidney transplant (RAKT), compared to patients that received conventional open kidney transplant (OKT), remain unknown. We performed a meta-analysis of controlled studies to compare the safety and efficacy of RAKT versus OKT. Methods. Systematic searching of PubMed, Embase, and Cochrane Library databases was performed to identify relevant randomized or nonrandomized controlled studies. Perioperative, in-hospital, and follow-up outcomes were summarized. A random-effect model incorporating the potential heterogeneity was used to synthesize the results. Results. Six nonrandomized controlled studies including 263 patients with RAKT and 804 patients with OKT were included. Pooled results showed that compared to those that received OKT, patients that received RAKT had significant higher rewarming time (mean difference (MD): 20.8 min, $p<0.001$ ) and total ischemia time (MD: 17.8 min, $p=0.008$ ) but a lower incidence of surgical site infection (SSI, risk ratio (RR): 0.22, $p=0.03$ ). The incidence of delayed graft function was comparable between groups (RR: 1.10, $p=0.82$ ), and the length of hospital stay was similar (MD: -2.03 days, $p=0.21$ ). During a follow-up of 31 months, patients that received RAKT and OKT had similar serum creatinine levels (MD: 10.12 mmol/L, $p=0.42$ ) and similar incidences of graft rejection (RR: 1.16, $p=0.53$ ), graft failure (RR: 0.94, $p=0.79$ ), and all-cause mortality (RR: 1.16, $p=0.77$ ). Conclusion. Current evidence from nonrandomized studies suggests that RAKT is associated with a lower risk of SSI and similar midterm functional and clinical efficacy compared to OKT. Randomized studies are needed to validate these findings.