Anesthetic outcomes in robotic kidney transplantation: a retrospective cohort analysis

Kidney transplantation is the definitive treatment for end-stage renal disease. Within the last decade, robotic-assisted kidney transplants have emerged as a promising alternative to the traditional open approach, but the impact on postoperative pain is unclear. We conducted a propensity-matched retrospective study to investigate postoperative pain control between open and robotic kidney transplant in adults at the University of Illinois Hospital from September 2020 to September 2025. The primary outcome was opioid consumption within 30 days after surgery. Secondary outcomes included the highest pain score within 72 hours of surgery, intraoperative opioid consumption, length of stay, and total hospital length of stay. Of 1379 patients, significant differences in baseline characteristics were observed between the open ( n = 1234) and robotic ( n = 145) approaches for age, weight and BMI. Propensity matching resulted in 127 pairs with no significant difference in opioid consumption within 30 days of surgery, intraoperative milligram morphine equivalents, highest pain score in recovery within 72 hours, and length of stay. Robotic cases were longer with less blood loss and required a smaller volume of packed red blood cell transfusions. Multivariate linear regression of 30-day morphine equivalents demonstrated a reduction in patients who were immediately extubated following completion of surgery. Robotic transplants resulted in similar postoperative opioid consumption and pain scores to open transplants but were longer and less bloody. Prolonged intubation after surgery contributed to opioid use. Our results contradict prior literature, which has reported reduced pain and opioid use with robotic approaches.