The Evolution of Kidney Transplantation Surgery into the Robotic Era and it prospects for obese recipients

Robotic-assisted kidney transplantation (RAKT) represents the most recent innovation in the evolution of kidney transplantation surgery. Vascular techniques enabling kidney transplantation have existed since the early 20th century and contributed to the first successful open kidney transplant procedure in 1954. Technical advances have since facilitated minimally invasive laparoscopic and robotic techniques in live-donor surgery, and subsequently for the recipient procedure. This review follows the development of surgical techniques for kidney transplantation, with a special focus on the advent of robotic-assisted transplantation because of its potential to facilitate transplantation of those deemed previously too obese to transplant by standard means. The different techniques, indications, advantages, disadvantages, and future directions of this approach will be explored in detail. Robot-assisted kidney transplantation may become the preferred means of transplanting morbidly obese recipients, although its availability to such recipients remains extremely limited and strategies targeting weight loss pretransplantation should never be abandoned in favor of a 'RAKT-first' approach. Corresponding author: Prof Howard Lau. Department of Surgery, Westmead Hospital, Cnr Darcy Road and Hawkesbury Road, Westmead, NSW 2145, Australia. Tel: +61 2 9635 5377. Email: drhlau@gmail.com Authorship A.M. Hameed participated in article content design, writing, and revision. J. Yao produced the supplementary digital content and participated in article writing, and revision. R. Allen participated in article content writing, and revision. W. Hawthorne participated in article content writing, and revision. H. Pleass participated in article content design/outline, writing, and revision. H. Lau participated in article content design/outline, writing, and revision. Disclosure and Funding The authors declare no conflicts of interest. Nil specific funding was received for this work. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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