*Purpose: Early experiences with multi-port robotic kidney transplantation have demonstrated a potential reduction in complications and improved convalescence while maintaining equivalent functional outcomes relative to the open approach. We present the technique and evaluate perioperative and short-term postoperative outcomes of single-port robotic-assisted kidney transplantation (RAKT) as a novel promising procedure to further reduce the morbidity of kidney transplantation.

*Methods: We prospectively evaluate the perioperative and postoperative outcomes after single-port RAKT in patients who underwent primary kidney transplant (n=6) between November 2019-2020. Kidney allografts from living (n=4) and deceased (n=2) donors were transplanted into six patients. Single-port robotic surgery was done by placement of a GelPOINT system through a 5cm midline infraumbilical abdominal incision after developing the extraperitoneal space. The da Vinci SP® robotic system was used to prepare the vascular bed. After extracorporeal preparation of the allograft, the robot was undocked and the kidney was introduced into the extraperitoneal space followed by re-docking. The SP robot was used to complete vascular and ureteral anastomoses.

*Results: Single-port RAKT was successfully completed without the need for conversion to any alternative approach in six patients with ESRD. Median age was 57 years (IQR: 55-60) with a median BMI of 28 (IQR: 23-37). Median operative time was 372 min (IQR: 367-439). Median arterial anastomosis time was 23 min (IQR:19-25) and Median vein anastomosis time was 28 min (IQR:28-29). Median hospital stay was 2 days (IQR: 2-3). Median Visual analogue score pain on discharge was 2 (IQR: 2-3). All patients had excellent graft function with serum creatinine levels at last follow- up ranging between 1.2-1.5 mg/dL.

*Conclusions: Single-port RAKT is feasible with comparable short-term graft functional outcomes. Compared to the multiport robot, it offers the benefit of being a true single-site minimally invasive surgery as well as recapitulating the open extraperitoneal approach which might further reduce the morbidity of kidney transplantation. While these early results are promising, larger series with longer follow-up are required.

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