Robotic-Assisted vs. Open Kidney Transplantation: A Systematic Review and Meta-Analysis of Propensity-Matched Studies

초록

OBJECTIVE: To compare the perioperative and follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT). METHODS: This systematic review and meta-analysis followed PRISMA 2020 guidelines and was registered in PROSPERO (CRD42022334583). RESULTS: Seven studies met the inclusion criteria, comprising a total of 1,263 kidney transplant cases (517 RAKT and 919 OKT). Compared to OKT, the RAKT group had shorter incision length (SMD = -9.00, p < 0.001), fewer overall postoperative complications (RR = 0.52, p = 0.024), and reduced Clavien-Dindo III-IV complications (RR = 0.58, p = 0.013). However, RAKT was associated with significantly longer warm ischemia time (SMD = 0.66, p < 0.001), cold ischemia time (SMD = 0.96, p = 0.011), rewarming time (SMD = 3.08, p = 0.053), and total ischemia time (SMD = 1.73, p = 0.054). No significant differences were observed in intraoperative complications (RR = 1.09, p = 0.898), delayed graft function (RR = 0.90, p = 0.750), reoperation rates (RR = 0.63, p = 0.354), or recipient survival at 1 year (RR = 1.00, p = 0.233). Graft survival at 1 year was slightly higher in the RAKT group (RR = 1.01, p = 0.031), with adjusted 1-year graft survival showing a significant advantage (RR = 1.03, p = 0.001). CONCLUSIONS: Despite perioperative benefits, RAKT does not demonstrate superior long-term graft survival or patient outcomes compared to OKT. Its adoption remains limited to specialized centers, and further high-quality studies are needed to clarify its clinical and economic impact. Copyright © 2025. Published by Elsevier Inc.

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