Efficacy of robot-assisted versus open kidney transplantation in obese patients: a systematic review and meta-analysis
Abstract
Background Obesity complicates open kidney transplantation (OKT), driving increasing interest in robot-assisted kidney transplantation (RAKT). This study compared intraoperative and postoperative outcomes of RAKT and OKT in patients with a body mass index ≥30 kg/m2. Methods Systematic searches of PubMed, Scopus, and the Cochrane Library were conducted through April 15, 2025. Four retrospective cohort studies (147 RAKT and 625 OKT cases) met the inclusion criteria. Pooled analyses evaluated cold and warm ischemia times, estimated blood loss, estimated glomerular filtration rate (eGFR) at 6 months and 1 year, serum creatinine at 6 months and 3 years, delayed graft function (DGF), graft survival at 1 and 3 years, length of stay, rejection rate, 1-year patient survival, and surgical site infection (SSI) using a random-effects model. Results No significant differences were observed in cold ischemia time (mean difference [MD], 43.88 minutes; 95% confidence interval [CI], –88.06 to 175.82 minutes; P=0.51), warm ischemia time (MD, 3.21 minutes; 95% CI, –3.23 to 9.65 minutes; P=0.33), or estimated blood loss (MD, –41.30 mL; 95% CI, –95.60 to 12.99 mL; P=0.14). Other postoperative outcomes, including graft function (eGFR and creatinine), DGF, hospital stay, rejection, and 1-year survival, were also comparable. However, RAKT was associated with a significantly lower SSI incidence (risk ratio, 0.14; 95% CI, 0.04–0.45; P=0.0009). Conclusions In obese patients, RAKT yields outcomes…
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