From Inception to Maturity: Learning Curve Analysis of Robot-Assisted Kidney Transplantation—A Single-Center Assessment

INTRODUCTION AND OBJECTIVES: The objective of this study was to analyze the impact of the learning curve in robot-assisted kidney transplant (RAKT) on both perioperative and long-term outcomes of the recipients. METHODS: A retrospective analysis was performed 9 years after the commencement of the RAKT program (2015) at our institute. Each group had patients with a single graft artery who were operated on over a period of 2 years (2016-2017: Group A; 2018-2019: Group B; 2020-2021: Group C; 2022-2023: Group D). Various clinico-demographic, intraoperative, and postoperative parameters were evaluated. Shewhart control charts and cumulative summation (CUSUM) graphs were generated to appraise the learning curve. RESULTS: Out of 202 patients who underwent RAKT with a single graft artery, Groups A, B, C, and D included 49, 49, 58, and 38 patients, respectively. Rewarming time, setup time, console time, vein and artery anastomosis time, ureteroneocystostomy time, total surgical time, blood loss, blood transfusion, hospital stay, and Clavien-Dindo Grades III and IV complications decreased significantly over time from Group A to Group D. CUSUM analysis showed an initial rise followed by a sustained decline in venous anastomosis time, intermittent fluctuations with a later decline in arterial anastomosis time, and an initial high rewarming time with gradual improvement. For delayed graft function, there was a consistent downward trend. One-year graft survival revealed a two-phase pattern, with initial challenges reflected in downward steps, followed by strong recovery and consistent improvement. CONCLUSION: RAKT can be safely adopted through a structured learning process with an initial phase of technical adaptation followed by consistent improvement. The learning curve for RAKT reflects both surgical expertise and team maturation.