*Purpose: Robotic Kidney Transplantation (RKT) is emerging modality of treatment for patient with end stage kidney diseases. It is accepted for obese recipients. However, there are no large studies comparing outcome of RKT and Open Kidney Transplantation (OKT). Our objective is to assess benefits of minimally invasive kidney transplantation surgery.

*Methods: This study was carried out as per declaration of Helsinki. Between January 2013 and April 2018, 400 RKT and 718 OKT were carried out. In RKT group, 356 patients were adults of which 303 were received kidney from living donor. In OKT group, 678 patients were adults of which 428 patients were had kidney from living donor. Exclusion criteria for RKT were patient with previous major abdominal surgery, glaucoma, hypertensive retinopathy grade III or IV, left ventricular ejection fraction <30, major cardio-respiratory problem and large space occupying kidneys in the abdomen. OKT was carried out in standard manner with external iliac vessels.

*Results: Data of both groups with living-donor were analyzed. Mean vascular anastomosis time, ureteric reimplantation time and blood loss were 31.29+-7.26 min and 32.00+-12.33 min (p=0.28), 30.80+-7.99 min and 41.64+-9.82 min (p=<0.01), 55.49+-89.27 ml and 119.05+-82.00 ml (p=<0.01) respectively for RKT and OKT. Mean wound length (6.9 cm+-0.9 cm and 18.8+-2.24 cm, p=<0.01), total analgesic requirement (2.5+-1.8 mg and 5.6+-2.8 mg morphine equivalent, p<0.01), time to resume orally (12.01+-4.6 hours and 13.9+-2.9 hours, p=<0.2), time to ambulation (12.36+-6.36 hours and 18.12+-5.35 hours, p=<0.03), time to catheter removal (3.5+-2.1 days and 3.8+-2.2 days, p=0.9) and hospital stay (8.7+-7.6 days and 8.9+-6.8 days, p=0.7) respectively for RKT and OKT. There was no difference in creatinine clearance at day 0, 1 week and 30 days. Graft survival at 1,3 and 5 years were similar in both groups. No perigraft collection was noticed in any patient of RKT while 6 patients required laparoscopic deroofing in OKT group. In 38 women recipients in RKT group, kidney was inserted through vagina. Five cases need to convert to open surgery in RKT group.

*Conclusions: RKT offers advantages of minimally invasive surgery over OKT in terms of smaller incision, less intra-operative blood loss, less analgesic requirement, and early ambulation with similar early creatinine clearance, graft survival and patient survival.

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