Robot-assisted Kidney Transplantation in Patients Undergoing Cystectomy with Urinary Diversion: First Cases Reported by the ERUS-RAKT Working Group

Robot-assisted kidney transplantation combined with robot-assisted simple cystectomy and intracorporeal urinary diversion is feasible and safe for patients with end-stage renal disease and a nonviable bladder owing to a benign condition. This novel strategy offers the potential to reduce surgical morbidity while maintaining stable graft function. However, its complexity requires expertise in robotic urology and transplantation, underscoring the need for referral to high-volume centers. The indication for kidney transplantation over a urinary diversion (UD) for patients with severe lower urinary tract dysfunction and end-stage renal disease is a controversial issue. Thanks to advances in robot-assisted kidney transplant (RAKT) programs, the boundaries are being pushed further. We present the first RAKT series reported for patients undergoing simple cystectomy and UD for benign bladder disease. The first case involved simultaneous robot-assisted simple cystectomy with intracorporeal UD and RAKT. The second case involved robot-assisted simple cystectomy with intracorporeal UD and bilateral nephrectomy in the first procedure, followed by RAKT 8 mo later. At 9 mo after surgery, both patients had experienced no complications and had stable renal function with no need for hemodialysis. This first experience of RAKT in patients with cystectomy and UD demonstrates the feasibility and safety of the procedure.