The Italian landscape of robotic-assisted kidney transplantation: results from a national survey.

Robotic-assisted kidney transplantation (RAKT) is an emerging minimally invasive alternative to open surgery that offers potential benefits in selected recipients. Despite increasing international interest, its implementation across transplant centers remains variable. This study aims to describe the current status, challenges, and perspectives on RAKT in Italy through a nationwide survey. A web-based questionnaire was distributed to all active kidney transplant centers in Italy. The survey collected data on institutional experience, surgical techniques, intraoperative technologies, perceived barriers, and future directions. Responses were anonymized and analyzed descriptively. Twenty-one out of 39 centers responded (54%). Nine centers were actively performing RAKT at the time of the survey. The median number of RAKT cases per center was 5 (range 1-85), with Da Vinci Xi being the most used platform. Intraoperative tools such as indocyanine green fluorescence and robotic Doppler were variably adopted to verify graft perfusion. Reported operative times ranged from 143 to 410 min (median 215 min), with low conversion rates. Main barriers to adoption included limited access to the robotic platform and lack of structured training. All centers supported the creation of a national registry and expressed interest in collaborative studies. This survey provides the first national overview of RAKT in Italy, highlighting both technical feasibility and structural challenges. The findings support the need for coordinated training efforts, shared data, and policy-level initiatives to foster equitable access to robotic transplant surgery.