Robotic-assisted simultaneous kidney-pancreas transplantation (RASPKT) without hand assistance: A retrospective cohort study showing a paradigm shift in minimally invasive transplant surgery

Abstract

Background: Simultaneous pancreas-kidney transplantation is the best option for patients with type 1 diabetes mellitus and end-stage kidney disease; however, the conventional open surgical approach is associated with a significant risk of pancreas allograft thrombosis, high morbidity, and prolonged hospital stays. Robotic-assisted simultaneous pancreas-kidney transplantation represents a paradigm shift in minimally invasive transplant surgery, offering the potential to reduce early postoperative complications. However, robotic-assisted simultaneous pancreas-kidney transplantation remains technically challenging, with previous approaches requiring GelPort device hand assistance in performing vascular and bowel anastomoses. Methods: In a retrospective cohort study, 4 patients underwent robotic-assisted simultaneous pancreas-kidney transplantation at our center using an intra-abdominal, hands-free robotic technique between September 2023 and November 2024. Early postoperative outcomes and measures of pancreas/kidney allograft function during the first 3-12 months posttransplant were analyzed. Results: Median operative time was 467.5 minutes (range, 399–543 minutes), with median pancreas and kidney warm ischemia times of 67 minutes and 57 minutes, respectively. Median length of hospital stay was 13.5 days (range, 8–18 days). No patients experienced vascular, urologic, or surgical complications; additionally, no pancreas allograft thrombosis nor rejection was observed. At 3 months posttransplant, all recipients achieved insulin independence, with glycated hemoglobin levels ≤5% and C-peptide levels ≥2.5 ng/mL. Kidney allografts also functioned effectively, with estimated glomerular filtration rates ranging from 37 mL/min to >90 mL/min and stable creatinine levels (0.7–1.82 mg/dL). Conclusion: This fully intra-abdominal, hands-free robotic approach to robotic-assisted simultaneous pancreas-kidney transplantation appears to be technically feasible and safe to perform, with excellent early clinical outcomes. However, larger studies with longer follow-up are required to confirm its clinical benefits and broader applicability.