In which kidney transplant recipients do you offer robotic over open transplantation now that the first randomized trial (ORAKTx) missed its primary endpoint?

The choice between robotic-assisted laparoscopy and open surgery for kidney transplantation generally falls on the comfort and experience level of the surgeon. We have done these robotically for three years. Virtually all primary cases can be done robotically, and it is especially attractive for obese recipients. As experience is gained, revascularization times are similar, if not less, with robotic surgery. While learning, it is best to create a single renal artery from multiple arteries ex vivo (on ice) prior to implantation. In complex cases such as retransplantation or prior lower abdominal or pelvic surgery, the open approach may still be preferred.

The ORAKTx trial was an important first step. The study was not powered correctly to draw conclusions, but the trends of fewer complications in the robot cohort are notable. I offer robotic transplant to every patient. There are no restrictions at our center. It's a better way to do the operation at our center, with notably faster recovery, less narcotics, shorter hospital stay, and better results at 1 and 3 years.