1.1 Current evidence on the safety and efficacy of robot-assisted kidney transplant is limited in quantity and quality. For patients with obesity who would not otherwise be able to have a kidney transplant without an unacceptable risk of morbidity, this procedure should only be used with special arrangements for clinical governance, consent, and audit or research. In patients for whom open kidney transplant surgery is suitable, this procedure should only be used in the context of research.
1.2 Clinicians wishing to do robot-assisted kidney transplant in people with obesity who would not otherwise be able to have a kidney transplant without an unacceptable risk of morbidity should:
Inform the clinical governance leads in their NHS trusts.
Ensure that patients understand the uncertainty about the procedure's safety and efficacy and provide them with clear written information to support shared decision-making. In addition, the use of NICE's information for the public is recommended.
Report details about all patients having robot-assisted kidney transplantation to NHS Blood and Transplant and review clinical outcomes locally. NICE has identified relevant audit criteria and has developed an audit tool (which is for use at local discretion).
1.3 Further research should include studies comparing robot-assisted kidney transplant with open surgery. This should collect data on patient selection, warm ischaemia times, the need for conversion to open surgery, graft function, and long-term graft and patient survival.
1.4 The procedure should only be done by teams of surgeons with experience in both transplant surgery and robotic surgery.