Robot-assisted urologic surgery after kidney transplantation: indications, graft-protection strategies, and outcomes—a scoping review

Abstract

Kidney transplantation relocates a vascularized graft and ureter into the iliac fossa, changing subsequent urologic surgery. Existing syntheses are procedure-specific. This scoping review mapped indications, graft-protection strategies, outcomes, and evidence gaps across robot-assisted urologic operations after kidney transplantation. PubMed/MEDLINE, Europe PMC, and Crossref were searched from inception through 25 July 2026; Scopus and Web of Science Core Collection were searched from inception through 26 July 2026, with citation searching.Peer-reviewed clinical reports in kidney-transplant recipients were eligible. Selection was performed independently by at least two authors; data charted by one author were independently source-checked by another. Methods followed a prespecified population-concept-context framework and PRISMA-ScR; heterogeneous results were synthesized descriptively. Of 1,963 records identified, 870 duplicates were removed, 1,093 were screened, and 68 reports were included: prostate surgery (26), transplant ureter reconstruction (21), bladder or pelvic extirpative surgery (7), allograft tumor surgery (6), transplant nephrectomy (5), and other procedures (3). The 463 procedures reported cannot be interpreted as unique patients. Evidence was most developed for radical prostatectomy and ureteral reconstruction. Graft-aware access, restricted ipsilateral dissection, native-ureter substitution, fluorescence or endoscopic mapping, and planned vascular control were recurring reported strategies. Recent uncontrolled ureteral cohorts reported 92.6–100% short- to intermediate-term success, but definitions varied. Other domains remained predominantly small series or case reports. Published reports document technical completion across diverse indications, predominantly in selected patients at experienced centers; these uncontrolled data do not establish comparative safety or effectiveness. Prospective multicenter studies using transplant-specific, standardized outcomes are the highest priority.