To compare the perioperative and follow-up outcomes between robot-assisted kidney transplantation (RAKT) and open kidney transplantation (OKT).

This systematic review and meta-analysis followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was registered in PROSPERO (CRD42022334583).

Seven studies met the inclusion criteria, comprising a total of 1263 kidney transplant cases (517 RAKT and 919 OKT). Compared to OKT, the RAKT group had shorter incision length (SMD = −9.00, P   < .001), fewer overall postoperative complications (RR = 0.52, P  = .024), and reduced Clavien-Dindo III-IV complications (RR = 0.58, P  = .013). However, RAKT was associated with significantly longer warm ischemia time (SMD = 0.66, P   < .001), cold ischemia time (SMD = 0.96, P  = .011), rewarming time (SMD = 3.08, P  = .053), and total ischemia time (SMD = 1.73, P  = .054). No significant differences were observed in intra-operative complications (RR = 1.09, P  = .898), delayed graft function (RR = 0.90, P  = .750), re-operation rates (RR = 0.63, P  = .354), or recipient survival at 1 year (RR = 1.00, P  = .233). Graft survival at 1 year was slightly higher in the RAKT group (RR = 1.01, P  = .031), with adjusted 1-year graft survival showing a significant advantage (RR = 1.03, P  = .001).

Despite perioperative benefits, RAKT does not demonstrate superior long-term graft survival or patient outcomes compared to OKT. Its adoption remains limited to specialized centers, and further high-quality studies are needed to clarify its clinical and economic impact.