Purpose: Robot-assisted kidney transplantation (RAKT) was introduced and has been performed commonly by surgeons experienced with robotic surgery. With this single center study we aimed to point out the important steps when we were implanting our RAKT program as transplant surgeons with no robotic surgery background.

Methods: The preparation period was detailed regarding mentors-supervisors, attended courses and, robotic practice prior to the RAKT. We retrospectively analyzed RAKT patients in terms of patient and donor characteristics, indications, console and rewarming times, times for vascular and ureterovesical anastomoses along with the postoperative complications and, patient and graft survivals.

Results: All RAKTs were performed by the same American Society of Transplant Surgeons certified transplant surgeon. First step was the intense simulator training and intense robotic training with vascular anastomosis model followed by the hands-on RAKT training courses at highly experienced institutions. Performing surgeon attended 3 standardized courses at different time points. The same surgeon performed 15 robot-assisted donor nephrectomies prior to the recipient operation. Out of 452 renal transplantation, we performed 24 RAKT between January 2020 and March 2022. The patient request was the indication for all RAKTs. Recipient surgeries were performed with Da Vinci Xi with allografts procured with hand-assisted laparoscopic donor nephrectomy. First 5 cases were carried out under the supervision of expert RAKT surgeons. The median recipient age was 32,5 years (range 16-58 years) with median BMI of 21.7 (range 15,8-33,3). The median console and rewarming times were 226 min (range 155-360 min) and 68 min (range 58-89 min) respectively. The median total vascular anastomosis time was 34 minutes (range 29-50 minutes), while the median ureterovesical anastomosis time was 27 min (range 16-60 min). There was no perioperative complications and 11 patients needed post-transplant blood transfusion. One patient underwent laparotomy for intestinal obstruction. There was no delayed graft function. Overall patient and graft survival rates were 100% with excellent graft function in the median follow up period of 9,6 months (range 0,1-26,3 months).

Conclusions: RAKT requires a very meticulous preparation for transplant surgeons with no robotic surgery background. Well training with standardized hands-on RAKT courses and cooperation between the surgeon and the assistants are crucial to reduce console and rewarming times.