ROBOT-ASSISTED kidney transplantation was associated with fewer major surgical and vascular complications than open transplantation, although neither difference reached statistical significance in the ORAKTx randomised trial. The open-label trial enrolled adults with end-stage kidney disease undergoing living or deceased donor kidney transplantation who had no contraindication to robotic surgery.
A total of 107 participants were randomly assigned to robot-assisted kidney transplantation or open surgery. 54 were allocated to the robotic arm and 53 to the open arm, with 53 participants in each group undergoing transplantation and completing follow-up.
The primary outcomes were rates of vascular and major surgical complications within 30 days of transplantation.
Major surgical complications occurred in seven patients (13%) receiving robot-assisted transplantation compared with 13 patients (25%) undergoing open surgery. The risk difference was −11% (95% confidence interval [CI]: −26 to 3.4; p=0.2), meaning the primary endpoint was not statistically significant.
Vascular complications were also less frequent with robot-assisted surgery, occurring in 9.4% of patients compared with 19% following open surgery, although the difference was not statistically significant (risk difference: −9.4%; 95% CI: −23 to 3.7; p=0.3).
Although the observed complication rates favoured robot-assisted kidney transplantation, the confidence intervals crossed zero for both outcomes, preventing a definitive conclusion that robotic surgery reduced complications compared with open transplantation.
The findings represent the first randomised comparison of robot-assisted and open kidney transplantation. While the primary endpoint was not met, the lower observed rates of both major surgical and vascular complications suggest that robot-assisted kidney transplantation could offer a clinically meaningful reduction in postoperative morbidity.
However, the findings should be interpreted in the context of several limitations. The trial was conducted at a single centre, participants and clinicians were not blinded, and the sample size was modest.
Further evidence will therefore be needed to determine whether the reduction in complications observed with robot-assisted kidney transplantation can be confirmed in larger and broader patient populations.
Reference
Ortved M et al. Open versus robot-assisted kidney transplantation in adults with end-stage kidney disease (ORAKTx): a randomised open-label trial. Eur Urol. 2026;90(3):202-9.
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