Introduction: Several centers have reported their recent experiences with the robotic approach in kidney transplantation. Previous reports suggest lower incidence of incisional hernia and lymphocele. However, these reported improvements in perioperative and follow-up outcomes are still debated. This most comprehensive and updated meta-analysis sought to compare the perioperative and follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT). Methods: For relevant articles, three electronic databases, including PubMed, Scopus, and Web of Science, were searched from their inception until May 21, 2022. A meta-analysis has been reported in line with PRISMA 2020 and AMSTAR Guidelines. The risk ratio (RR) and mean difference (MD) were applied for the comparison of dichotomous and continuous variables with 95% confidence intervals (CI). Results: Of the 1580 retrieved abstracts, 95 underwent full-text review, and 15 studies were included in the final analysis, comprising a total cohort of 2,319 cases of kidney transplantation (667 RAKT and 1,652 OKT). The quality of the studies remains low with large heterogeneity in the cohorts. the RAKT group still has longer warm ischemia time, cold ischemia time, rewarming time, total ischemia time and operative time compared to the OKT group. Even though RAKT group had shorter incision length (RR = 1.42, 95%CI (0.350 - 5.766), p=0.623) resulting in lower pain score (MD = -1.37, 95%CI (-1.59 - -1.15), p= <0.001), less morphine use (SMD = -3.478, 95%CI (-5.619 - -1.336), p=0.001), and shorter length of stay (LOS) (SMD = -0.496, 95%CI (-0.819 - -0.173), p=0.003), it has similar clinical estimated blood loss, similar rates of surgical site hernia and postoperative lymphocele. Both techniques have equivalent renal function, graft, and patient survival. Decrease surgical site infection remains only significant in obese patients. Conclusions: Our study showed that with a larger series and more patients, the initial promise that RAKT have lower rates rate of lymphocele incisional hernia is not true. While RKT does have shorter wound incision, less pain, and LOS, this comes at a cost of longer op times with no improvement in graft survival. The answer to whether RAKT is worthwhile remains to be answered by a randomized controlled study. SOURCE OF Funding: None
