*Purpose: Obesity with end-stage renal disease significantly impacts intraoperative and postoperative complications in kidney transplantation. Robot-assist procedures have been an attractive modality to overcome barriers in morbid obese patients. The present study aimed to evaluate the short-term outcome of robotic-assisted kidney transplant (RAKT) in the first year at new single institution.

*Methods: From October 2017 to October 2018, we enrolled consecutive cases of RAKT in University of Virginia. Operative and clinical features including graft and patient survivals were retrospectively analyzed.

*Results: Eight patients successfully underwent RAKT (4 deceased and 3 living donors). Median age is 48 years old (29-67). Pre-transplant body mass index (BMI) was 39.5 (32-44.7). Operation time and estimated blood loss were 341 min (217-375) and 150cc (50-250), respectively. Total cold ischemic time and warm ischemic time were 1103 min (73-1515) and 45 min (40-52), respectively. No patient was converted to open method. No major complications during surgery were observed. We reported two cases of delayed graft function and two cases of rejection, with complete resolution and normal subsequent graft function. We found one wound dehiscence, one deep vein thrombosis, and one revision of ureterocystostomy for stricture that was robotically completed. No graft loss and patient death was noted.

*Conclusions: RAKT for obese patients appears to be a safe surgical procedure and has potential advantages of reduced wound complications, quality of vascular anastomosis, and shorter recovery compared to conventional open surgery in obese recipients.

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