Robotic versus laparoscopic versus open nephrectomy for live kidney donors

Area of Science:

• Nephrology and Transplant Surgery
• Minimally Invasive Surgical Techniques
• Live Kidney Donation Outcomes

Background:

• Growing kidney transplant waiting lists necessitate increased live kidney donation.
• Donor surgical pain and morbidity are significant barriers to live donation.
• This review updates evidence on surgical techniques for live kidney donors.

Approach:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Comparison of open donor nephrectomy (ODN), laparoscopic donor nephrectomy (LDN), hand-assisted LDN (HALDN), and robotic donor nephrectomy (RDN).
• Assessment of donor outcomes including pain, complications, and recovery.

Key Points:

• LDN demonstrates reduced analgesia use and shorter hospital stays versus ODN, with comparable blood loss and perioperative complications.
• HALDN and RDN show comparable outcomes to LDN regarding pain, hospital stay, and complications, though warm ischemia times may vary.
• Conversion rates to ODN were low across all minimally invasive techniques (LDN, HALDN, RDN).

Conclusions:

• Laparoscopic donor nephrectomy (LDN) offers significant advantages in pain reduction and recovery compared to open donor nephrectomy (ODN).
• Hand-assisted LDN (HALDN) and robotic donor nephrectomy (RDN) present comparable donor outcomes to LDN, with potential variations in warm ischemia time.
• Surgical technique advancements are improving donor safety and experience in live kidney donation.