EURURO Vol. 72 No. 2

219 320

it is the technique most commonly used worldwide. Once
its feasibility and safety were proven, the world experience
was collected, including a few small RCTs that showed equal
efficacy and less invasion, and the approach became the
standard of care.
After many years of experimental work on LKT, including
our own, and several attempts in a small number of
patients, only one group was able to establish a stable and
durable program . These authors recognised the extreme
difficulty of the technique and recorded loss of two grafts in
their early experience. Renewed enthusiasm emerged with
the arrival of robotics. Nowadays, LKT has been replaced by
RKT. The use of articulated instruments, together with
three-dimensional vision (already available in laparoscopy),
potentially allows a reduction in warm ischaemia time
(WIT) by reducing the revascularisation suture time.
The world experience is actually recent. It begun in 2009,
since [4_TD$DIFF]then more than 500 RKT procedures have been
performed. However, approximately 70% of the world
experience is concentrated in two Indian institutions, the
Mehta Institute (Ahmedabad) and Medanta Hospital
(Gurgao) , with the support of the Vattikuti Urology
Institute (Detroit, MI, USA) Several institutions in
Europe have implemented the procedure, mainly using the
Medanta technique, and a European register (ERUS) has
been created that already includes 100 patients who have
received a transplant.
From the European experience, including our own
department, it can be said that RKT is a technique that is
already systematised, is reproducible, and has yielded
equivalent results to OKT in terms of graft and patient
survival. As a result of the longer WIT and the probably
negative effect of pneumoperitoneum, slower recovery of
renal function can be observed, but there are no differences
after 3 mo. Cooling of the kidney during the procedure is
probably the most important unsolved problem that
hampers speed in revascularising the kidney, with all the
associated complications in terms of stress and quality of
the sutures.
RKT allows early recovery, especially in obese patients,
and better cosmesis, mainly because of the smaller incision
used exclusively to introduce the kidney into the abdominal
cavity. This incision can be avoided in some women by
using a transvaginal approach, a route for which there is
wide experience for kidney retrieval .
Conflicts of interest: The authors have nothing to disclose.
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