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

Minimally invasive donor nephrectomy has been shown to be procedurally safe; however, rates of minor complications vary significantly, and long-term surgical complications remain underreported in an era of changing surgical practice. The incidence and predictive factors of incisional hernia (IH) after donor nephrectomy remain underinvestigated, especially with regard to robotic-assisted donor nephrectomy (RADN).

A single-institution retrospective analysis of consecutive kidney donors between January 2017 and December 2025 was conducted. Donors were categorized by surgical approach into laparoscopic hand assisted donor nephrectomy (LHDN) and robotic-assisted donor nephrectomy cohorts (RADN). Predictive factors for IH development were analyzed using multivariable regression.

There were 325 donors during the study period, 228 (70.1%) LHDN and 97 (29.8%) RADN. There were 24 donors who developed IH (7.4%). There was not a significant difference in IH rate by surgical approach (7.0% vs. 8.2%, P = 0.8). While operative time was longer in the RADN cohort (250 vs. 306 min., P < 0.001), there was no significant difference in perioperative complications, length of stay, or readmission (all P > 0.05). On multivariable analysis, both class I obesity (HR 2.75, 95% CI 1.28-6.41) and male sex (HR 2.19, 95% CI 0.99-4.89) were both independently associated with IH development.

In this study, LHDN and RADN had comparable incidence rates of IH. Both obesity and male sex were demonstrated to significantly increase IH likelihood, regardless of surgical technique. While kidney donors with mild obesity have been increasingly accepted, transplant centers should be aware of the significant effect of even mild obesity on IH risk, particularly in male donors.