Innovations in Post-Transplant Urology: A Systematic Review of Robot-Assisted Ureteral Reconstruction Procedures after Kidney Transplantation.

PURPOSE: Ureteral complications are among the most common types of complications following kidney transplantation (KT). In the past, these complications were often managed using endoscopic and open surgical approaches. However, the robot-assisted approach has been recently implemented. Nevertheless, the available data regarding the potential impact of robotic surgery in this field are sparse. This systematic review (SR) aims to summarize the available evidence of robot-assisted ureteral reconstruction following KT, focusing on postoperative outcomes and complications.

METHODS

Studies eligible for inclusion focused on evaluating the success and/or complications associated with robot-assisted ureteral reconstruction after KT. An SR was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. The literature search was performed using the Web of Science, PubMed, and Scopus databases, with no restrictions on the time period. Only articles published in English were considered.

RESULTS

After screening 5337 publications, this SR included 9 studies with a total of 127 patients. The most common indication for reconstruction was ureteral stricture (n = 108, 85%), and the most frequently performed procedure was ureteroneocystostomy (n = 59, 46.8%). Following robot-assisted ureteral reconstruction procedures, the average success rate was 91.3%. Regarding intraoperative complications, six patients (4.7%) required conversion to open surgery. As for postoperative complications, the number of patients experiencing Clavien-Dindo Grade 1, 2, 3, and 4 complications were 15/121 (12.4%), 20/121 (16.5%), 4/121 (3.3%), and 2/121 (1.6%), respectively.

CONCLUSION

With the advancements in robotic platforms as well as KT surgeons' expertise in minimally invasive surgery, robot-assisted ureteral reconstruction after KT is increasingly recognized as a safe and effective option for recipients with ureteral complications.