Robotic donor nephrectomy: optimizing outcomes beyond the limitations of laparoscopy

Area of Science:

• Urology
• Minimally Invasive Surgery
• Transplant Surgery

Background:

• Robotic donor nephrectomy (RDN) offers advantages over laparoscopic donor nephrectomy (LDN) including enhanced visualization and ergonomics.
• Concerns remain regarding the safe transition from LDN to RDN procedures.

Purpose of the Study:

• To evaluate the safety and efficiency of robotic donor nephrectomy (RDN) during its initial learning curve.
• To compare outcomes between RDN and laparoscopic donor nephrectomy (LDN).

Main Methods:

• Retrospective review of 150 living donor nephrectomies (75 LDN, 75 RDN).
• Comparison of operative times and complication rates between the first 75 RDN cases and the last 75 LDN cases.
• Analysis of donor morbidity and recipient outcomes.

Main Results:

• RDN had longer operative times (182 min) compared to LDN (144 min) (P < 0.0001).
• RDN resulted in a shorter postoperative length of stay (1.8 days) versus LDN (2.1 days) (P = 0.0213).
• Donor complications and recipient outcomes were comparable between RDN and LDN groups. The RDN learning curve was estimated at 30 cases.

Conclusions:

• RDN is a safe alternative to LDN, with acceptable donor morbidity and no adverse impact on recipient outcomes, even early in the learning curve.
• Further investigation is needed to understand surgeon preferences for robotic versus laparoscopic approaches to optimize ergonomics and efficiency.