Overcoming surgical challenges with robotic assistance: robot-assisted nephrectomy of a failed renal allograft after complex en-bloc dual kidney transplantation

We present the case of a 37-year-old male who underwent infant donor en-bloc dual kidney transplantation (EBKT) and subsequently developed left allograft failure with severe refractory urinary tract infection secondary to long-standing ureteropelvic junction obstruction and hydronephrosis. After failure of conservative anti-infective therapy to control recurrent infection, the patient underwent successful robot-assisted extracapsular allograft nephrectomy (ECAN), with the primary surgical indication of eradicating the source of refractory infection in the obstructed, completely non-functional allograft. The procedure was completed in 145 min with minimal blood loss (20 mL). The patient was discharged on postoperative day 5 with complete resolution of symptoms and preserved function of the contralateral viable graft. This case demonstrates that robot-assisted surgery offers a safe and precise surgical option for failed allograft nephrectomy after complex pediatric EBKT, with favorable perioperative outcomes in this specific scenario involving distorted anatomy and severe adhesions.