*Purpose: The dialysis dependent patient population is growing more obese and finding innovative ways to make them transplant candidates is important. Here in we demonstrate how robotic assistance in kidney transplantation provides a platform to treat these patients.

*Methods: Retrospective analysis of 239 robotic-assisted kidney transplants performed from January 2009 to November 7^th, 2018. Additionally, 8 patients had their surgeries converted to open fashion due to issues with the vascular anastomosis or bleeding that was uncontrollable robotically (3.3%). Surgical outcomes, intra-operative details and post-operative courses have been described with clinical follow-up (kidney function, patient and graft survival).

*Results: The average pre-transplant BMI was of 41.6±6.6 kg/m² with more than half the patients being African-American. Living donor transplants were performed in 66.5% of the cases. The average length of surgery was 4.9±1.2 hours with a warm ischemia time of 46.7±13.0 minutes. Surgical site infections occurred at a rate of 0.5%. Five patients required minimally invasive revision of the urinary anastomosis due to leak. Graft thrombosis occurred in only 1 patient. Mean creatinine was down to 1.5±0.7 mg/dL by 1-year. The mean follow-up was 29.1±22.2 months. 1 and 3-years patient survival was 97.4 and 94.2% and graft survival was 97.5 and 92.9%, respectively.

*Conclusions: By minimizing surgical trauma and alleviating surgical site infections in this vulnerable patient population, robotic kidney transplantation in obese recipients allows achievement of optimal graft outcomes, comparable to their non-obese counterparts.

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