Robotic-assisted Donor Nephrectomy: As Safe as Laparoscopic Donor Nephrectomy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Transplant Surgery

Background:

• Robotic-assisted donor nephrectomy is gaining popularity.
• Laparoscopic donor nephrectomy is an established minimally invasive technique.

Purpose of the Study:

• To compare outcomes of robotic-assisted donor nephrectomy with a historical cohort of laparoscopic donor nephrectomies.
• To evaluate the safety and efficacy of robotic-assisted donor nephrectomy, particularly in complex cases.

Main Methods:

• Retrospective review of 58 consecutive donor nephrectomies (32 robotic-assisted, 26 laparoscopic) performed between 2015 and 2019.
• Comparison of key operative outcomes including blood loss, length of stay, warm ischemia time, and complication rates.

Main Results:

• Robotic and laparoscopic approaches demonstrated comparable blood loss, length of stay, and post-operative creatinine changes.
• Robotic cases had longer warm ischemia times and operative durations, with a higher incidence of right-sided procedures and vascular multiplicity.
• One complication (Clavien II or greater) occurred in the robotic group; none in the laparoscopic group.

Conclusions:

• Robotic-assisted donor nephrectomy is a safe alternative to the laparoscopic approach with similar patient outcomes.
• The robotic technique facilitates safe completion of complex donor nephrectomies, including right-sided and multi-vascular cases.
• Initial longer operative times for robotic procedures are likely due to surgeon learning curve, with times improving over the study period.