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Objective To report the results of the robot-assisted kidney transplantation (RAKT) experience performed in 10 European centres by members of the European Robotic Urology Section (ERUS)-RAKT group. Patients and Methods This is a multicentre prospective observational study of RAKT. Descriptive analysis of recipients and donor characteristics, surgical data, intraoperative outcomes, complications rate and functional results were collected and analysed. Results Between July 2015 and September 2019, 291 living-donor RAKTs were performed. Recipients were mostly male (189 [65%]), the mean Standard deviation (sd)age was 45.2 (13.35) years, the mean (sd)body mass index was 27.13 (19.28) kg/m(2), and RAKT was pre-emptive in 155 (53.8%) cases. Right and multiple arteries kidneys were used in 15.4%. The mean (sd)total surgical and re-warming time was 244 (70.5) min and 53.16 (15.27) min, respectively. In all, 17 patients presented with postoperative bleeding (5.7%). Five kidneys had delayed graft function; five (2%) were lost due to thrombosis and one due to acute rejection. Two patients had arterial stenosis, three had incisional hernias, six had ureteric stenosis, and nine had lymphoceles. Neither surgical nor re-warming times were correlated with postoperative serum creatinine levels (P > 0.05). Comparison of surgical data between the first 120 cases and the following 171 cases showed a significantly shorter total surgical time in the second group (265 vs 230 min,P = 0.005). Conclusions This is the largest European multicentre study of RAKT with good surgical and functional results competitive with open kidney transplant series, with a relatively short learning curve when performed in centres with a wide experience in open kidney transplantation and robotic surgery.

Background: Recently, robot-assisted kidney transplantation (RAKT) was recently introduced as renal replacement mini-invasive surgery. Objective: To report surgical technique, including tips and tricks, and the learning curve for RAKT. Design, setting, and participants: All consecutive RAKTs performed in the five highest-volume centers of the European Robotic Urological Society RAKT group were reviewed, and a step-by-step description of the technique was compiled. Surgical procedure: Surgeries were performed with Da Vinci Si/Xi. The patient was placed in the lithotomy position. The Trendelenburg position was set at 20-30 degrees and the robot was docked between the legs. Measurements: Shewhart control charts and cumulative summation (CUSUM) graphs and trifecta were generated to assess the learning curve according to rewarming time (RWT), intra/postoperative complications, and renal graft function (glomerular filtration rate) on days 7 and 30, and at 1 yr. Linear regressions were performed to compare the learning curves of each surgeon. Results and limitations: Arterial anastomosis time was below the alarm/alert line in 93.3%/ 88.9% of RAKTs, while venous anastomosis time was below the alarm/alert line in 88.9%/73.9%. The nonanastomotic RWT exceeded +3 standard deviation (SD) in 24.7% of procedures and +2SD in 37.1%. In only 46% cases, the RWT was below the alert line. The ureteroneocystostomy time was below +2SD and +3SD in 87.9% and 90.2% of cases, respectively. CUSUM showed that the learning curve for arterial anastomosis required up to 35 (mean = 16) cases. Complications and delayed graft function rates decreased significantly and reached a plateau after the first 20 cases. Trifecta was achieved in 75% (24/32) of the cases after the first 34 RAKTs in each center. Conclusions: A minimum of 35 cases are necessary to reach reproducibility in terms of RWT, complications, and functional results. Patient summary: Robot-assisted kidney transplantation requires a learning curve of 35 cases to achieve reproducibility in terms of timing, complications, and functional results. Synergy between the surgeon and the assistant is crucial to reduce rewarming time. High-grade complications and delayed graft function are rare after ten surgeries. Hands-on training and proctorship are highly recommended. (c) 2019 European Association of Urology. Published by Elsevier B.V. All rights reserved.

Objective: Laparoscopic-endoscopic single-site surgery (LESS) is a nearly scarless surgical technique. The aim was to assess the results of our initial LESS retroperitoneal ureterolithotomy (LESS-RU) experience and our technique. Material and methods: Primary indication for LESS-RU procedure in this study was obstructive or impacted ureteral stone(s) larger than 15 mm and located in the middle or upper part of the ureter in those patients in whom prior interventions have failed. Eighteen patients underwent LESS-RU for upper or middle ureteric stone by one experienced laparoscopist, between December 2008 and December 2009. Patient characteristics, operative details, complications, use of analgesic medication and time to return to work were recorded. Results: Eighteen cases were successfully accomplished. The mean patient age was 40.1 yr (19-60 yr), and median BMI was 27.7 kg/m2 (21-32). The mean operative time was 69.9 min (50-150 min), and the mean blood loss was 31.9 ml (20-70 ml). Mean stone size was 18.1 mm (range: 16-22). No patient required morphine for pain relief and the main use of oral analgesics was for two days. In postoperative follow-up there was a minimally scar and good cosmetic results were detected. Conclusions: LESS-RU proved to be safe and feasible. We think that LESS-RU will take place of laparoscopic ureterolithotomy in the near future with better cosmetic results. Further clinical investigation in comparison to the established techniques should take place to evaluate the outcome of LESS-RU.