Incisional hernia after laparoscopic and robotic donor nephrectomy: analysis of 325 consecutive donors

Area of Science:

• Nephrology
• Transplant Surgery
• Minimally Invasive Surgery

Background:

• Minimally invasive donor nephrectomy is safe, but minor complication rates vary.
• Long-term complications like incisional hernia (IH) after donor nephrectomy are underreported.
• Predictive factors for IH, particularly after robotic-assisted donor nephrectomy (RADN), require further investigation.

Purpose of the Study:

• To investigate the incidence and predictive factors of incisional hernia (IH) after donor nephrectomy.
• To compare IH rates between laparoscopic hand-assisted donor nephrectomy (LHDN) and robotic-assisted donor nephrectomy (RADN).
• To identify risk factors associated with IH development in kidney donors.

Main Methods:

• Retrospective analysis of kidney donors from January 2017 to December 2025.
• Categorization of donors by surgical approach: LHDN vs. RADN.
• Multivariable regression analysis to identify predictive factors for IH development.

Main Results:

• A total of 325 donors were analyzed; 24 (7.4%) developed IH.
• IH rates were comparable between LHDN (7.0%) and RADN (8.2%) cohorts (P=0.8).
• Class I obesity (HR 2.75) and male sex (HR 2.19) were independently associated with increased IH risk.

Conclusions:

• LHDN and RADN demonstrate similar IH incidence rates.
• Obesity and male sex are significant risk factors for IH in kidney donors, irrespective of surgical technique.
• Transplant centers should consider the heightened IH risk in mildly obese male kidney donors, even with minimally invasive approaches.