Feasibility of simultaneous donor nephrectomy and kidney transplantation using a shared single-port robotic platform

Single-port (SP) robotic platforms are enabling new approaches to living donor nephrectomy and kidney transplantation, but limited access to robotic systems may prevent simultaneous donor and recipient procedures. This retrospective cohort study evaluated the feasibility, safety, and efficiency of a simultaneous SP robotic workflow using a single robotic platform for both operations. 45 living kidney donor/recipient operations were performed between October 2019 and September 2025. 15 pairs underwent a simultaneous SP robotic approach in which both donor nephrectomy and recipient transplant were completed using the same SP robotic platform, while 30 cases underwent laparoscopic donor nephrectomy followed by SP robotic kidney transplantation. Outcomes included operative time, graft ischemia times, perioperative complications, pain scores, length of stay, and graft function. Baseline donor characteristics were similar between groups. SP robotic donor nephrectomy had longer operative time than laparoscopic nephrectomy (median 4:10 vs. 3:07 h, p = 0.001), while warm ischemia time, blood loss, length of stay, and renal function were comparable. Donors in the SP group reported lower postoperative day 1 pain scores (p = 0.03). In recipients, the simultaneous SP robotic approach resulted in a shorter operative time (3:54 vs. 4:41 h, p = 0.015) and anastomosis time (44 vs. 52.5 min, p = 0.007), with no differences in cold ischemia time, complications, or graft function. Overall, this study presents a novel, resource-efficient surgical model that enables dual robotic procedures using a single platform without compromising outcomes.